Provider Demographics
NPI:1790373975
Name:PEARSON, JENTRY MCCLARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENTRY
Middle Name:MCCLARD
Last Name:PEARSON
Suffix:
Gender:M
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 1:238 POYDRAS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2550
Mailing Address - Country:US
Mailing Address - Phone:318-553-5094
Mailing Address - Fax:
Practice Address - Street 1:238 POYDRAS AVE
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2550
Practice Address - Country:US
Practice Address - Phone:318-553-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10457R2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports