Sportmedica, LLC
Rehabilitation Hospital in Shreveport, LA. Organization (NPI-2).
NPI number1124499751
StatusActive
Last updated in NPPESOct 8, 2015
Details
- NPI
- 1124499751
- Entity type
- Organization (NPI-2)
- Legal business name
- Sportmedica, LLC
- Organization subpart
- No
- Enumeration date
- Oct 8, 2015
- Last updated
- Oct 8, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 283X00000X | Rehabilitation Hospital | MD.014596 | LA | Yes |
Practice location
2934 Chardonnay CirShreveport, LA 71106-8418
Phone 318-458-8490
Mailing address
2934 Chardonnay CirShreveport, LA 71106-8418
Phone 318-458-8490
Authorized official
William Overdyke
Medical Physician/ Owner
3184588490
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