Provider Demographics
NPI:1790521334
Name:KNEIP, MARY C (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:KNEIP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:KAYSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:537 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-5919
Mailing Address - Country:US
Mailing Address - Phone:318-560-0409
Mailing Address - Fax:
Practice Address - Street 1:460 ASHLEY RIDGE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7238
Practice Address - Country:US
Practice Address - Phone:318-868-6172
Practice Address - Fax:318-868-6173
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist