| Organization Name: | THERATEAM OUTPATIENT SERVICES, LLC |
| NPI Number: | 1821333055 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRENT SHEPHERD (ADMINISTRATOR) |
| Mailing Address: | 4615 Highway 80 Haughton |
| State: | LA US |
| Postal Code: | 710377441 |
| Phone Number: | 3185180584 |
| Fax Number: | |
| NPI Enumeration Date: | 11/28/2012 |
| NPI Last Update Date: | 11/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 04785 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |