Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 07638 | LA |
NPI | 1003046079 |
---|---|
Provider Name | Suzannah Kathryn York - Crump |
First Address | Shreveport, LA 71106-8376 |
Second Address | Shreveport, LA 71105-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 17/03/2014 |