Provider Demographics
NPI:1326163130
Name:SOWELL, KEVIN THOMAS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:THOMAS
Last Name:SOWELL
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:SOWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:457 ASHLEY RIDGE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7229
Mailing Address - Country:US
Mailing Address - Phone:318-219-7737
Mailing Address - Fax:318-219-7739
Practice Address - Street 1:457 ASHLEY RIDGE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7229
Practice Address - Country:US
Practice Address - Phone:318-219-7737
Practice Address - Fax:318-219-7739
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA03183OtherSTATE LICENSE