Active NPI
Betty Lynette Crain, PTA
- Physical Therapy Assistant
- Shreveport, LA
National Provider Identifier
1114076353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A4064
- Practice address
- 1800 Buckner St
Suite C200
Shreveport, LA 71101-4440 - Phone
- (318) 227-2009
- Fax
- (318) 227-9025
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A4064 | LA | Primary |
Addresses
Primary practice location
1800 Buckner St
Suite C200
Shreveport, LA 71101-4440
Mailing address
1800 Buckner St
Suite C200
Shreveport, LA 71101-4440
Phone (318) 227-2009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A4064 | LA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114076353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 BUCKNER ST",
"address_2": "SUITE C200",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014440",
"telephone_number": "318-227-2009",
"fax_number": "318-227-9025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 BUCKNER ST",
"address_2": "SUITE C200",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014440",
"telephone_number": "318-227-2009",
"fax_number": "318-227-9025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRAIN",
"first_name": "BETTY",
"middle_name": "LYNETTE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "LA",
"license": "A4064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.