Provider Demographics
NPI:1912259029
Name:GREEN, ERNEST LOESSNER (DPT)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:LOESSNER
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 CYPRESS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7674
Mailing Address - Country:US
Mailing Address - Phone:318-397-3331
Mailing Address - Fax:318-397-3336
Practice Address - Street 1:4920 CYPRESS ST
Practice Address - Street 2:SUITE C
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7674
Practice Address - Country:US
Practice Address - Phone:318-397-3331
Practice Address - Fax:318-397-3336
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist