Provider Demographics
NPI:1386705036
Name:PROMOTING LIVELIHOOD AND ABILITY IN YOUTH PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PROMOTING LIVELIHOOD AND ABILITY IN YOUTH PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:318-227-9002
Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:SUITE C-200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-227-9002
Mailing Address - Fax:318-227-9025
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:SUITE C-200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-227-9002
Practice Address - Fax:318-227-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy