Basic Information
| Provider Information | |||||||||
| NPI: | 1720568173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARLAND | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | S | ||||||||
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| OtherLastName: | SLACK | ||||||||
| OtherFirstName: | KELLY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2001 DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391019 | ||||||||
| FaxNumber: | 3185391063 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 REYNOLDS ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710753444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185394006 | ||||||||
| FaxNumber: | 3185394006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 03235 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.