Provider Demographics
NPI:1457125940
Name:ARCH PHYSICAL THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:ARCH PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT,DIPOSTEOPRACTIC
Authorized Official - Phone:614-284-2956
Mailing Address - Street 1:407 OAKWOOD TRACE CT
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8314
Mailing Address - Country:US
Mailing Address - Phone:614-284-2956
Mailing Address - Fax:
Practice Address - Street 1:7591 FERN AVE STE 1203
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5763
Practice Address - Country:US
Practice Address - Phone:318-828-2972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty