Provider Demographics
NPI:1801819768
Name:FENTER, PAULA (PT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:FENTER
Suffix:
Gender:F
Credentials:PT
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 CLAIBORNE AVE
Mailing Address - Street 2:LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONS
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4204
Mailing Address - Country:US
Mailing Address - Phone:318-813-2970
Mailing Address - Fax:318-813-2981
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONS
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-813-2962
Practice Address - Fax:318-813-2975
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174173Medicaid
LA196550Medicare ID - Type UnspecifiedGROUP MC #