Provider Demographics
NPI:1891301669
Name:VIET, JAN SOFRIDES (LPT)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:SOFRIDES
Last Name:VIET
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 DUDLEY LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2902
Mailing Address - Country:US
Mailing Address - Phone:936-676-8822
Mailing Address - Fax:
Practice Address - Street 1:1120 DUDLEY LN
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2902
Practice Address - Country:US
Practice Address - Phone:936-676-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist