Provider Demographics
NPI:1770201824
Name:BETON, LOU WELLA EMPUERTO (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:LOU WELLA
Middle Name:EMPUERTO
Last Name:BETON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2765
Mailing Address - Country:US
Mailing Address - Phone:318-557-2858
Mailing Address - Fax:
Practice Address - Street 1:1014 SUNSHINE LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2765
Practice Address - Country:US
Practice Address - Phone:318-557-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07535F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist