Provider Demographics
NPI:1841316171
Name:PICKARD, VICKI SU (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:SU
Last Name:PICKARD
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10016 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2814
Mailing Address - Country:US
Mailing Address - Phone:318-426-2416
Mailing Address - Fax:318-798-2765
Practice Address - Street 1:10016 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2814
Practice Address - Country:US
Practice Address - Phone:318-426-2416
Practice Address - Fax:318-798-2765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist