Therateam Outpatient Services, LLC
Organization Active NPI Orthopedic Physical Therapist · Haughton, LA
NPI 1821333055 · NPPES record last updated Feb 27, 2023
Key facts
- NPI
- 1821333055
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- 04785 (LA)
- Legal business name
- THERATEAM OUTPATIENT SERVICES, LLC
- Practice address
- 4615 Highway 80
Haughton, LA 71037-7441 - Phone
- (318) 615-3003
- Fax
- (318) 615-3004
- NPI assigned
- Nov 28, 2012
- Organization subpart
- No
Authorized official
- Name
- Trent Shepherd, P.T.
- Title
- Administrator
- Phone
- (318) 518-0584
Practitioners 15
-
Lance Danos, PT, DPT
-
Joe F Bienvenu, O.T.
-
Russel Bienvenu, OT
-
Lauren Burkett, MOT, OTR/L
-
Richard Busch, OT
-
David Hebert, PT
-
Jeremiah Rivers, P.T.
-
Ronnie A Wagley Jr., M.P.T.
-
Lauren Michelle Dean, CCC-SLP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140225002228 | LA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5597995233 |
Receives reassigned benefits from 6 practitioners Practice locations: Bossier City, LA; Haughton, LA; Shreveport, LA |
National Provider Directory
Locations
1700 Old Minden Rd
Ste 180
Bossier City, LA 71111
Phone (318) 562-3944
4615 Highway 80
Ste 9
Haughton, LA 71037
Phone (318) 518-0548
4615 Highway 80
Haughton, LA 71037
Phone (318) 615-3003
6723 Pines Rd
Shreveport, LA 71129
6723 Pines Rd
Ste 112
Shreveport, LA 71129
Phone (318) 562-3944
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist |
2251X0800X | 04785 | LA | Yes |
Addresses
Primary practice location
4615 Highway 80
Haughton, LA 71037-7441
Mailing address
101 Isadore St
Natchitoches, LA 71457-5747
Phone (318) 238-2810
Other practice location 1
6723 Pines Rd Ste 112
Shreveport, LA 71129-2590
Phone (318) 562-3944
Other providers in Haughton, LA
- Jennifer M Smith
- Lisa Lynn Smith
- Sports Orthopedic & Spine Therapy of Louisiana, LLC
- Patricia A Ta
- Taylormade Transport
- Thomas G Latiolais MD
- Tanikqa Thomas
- Geneva Sheree Toms
- Patricia Palmer Trim
- Amber Callahan Tullos
All providers in Haughton, LA · Orthopedic Physical Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.