BLAINE MICHAEL THEODOS

SHREVEPORT, LA
NPI1730019720
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: LA  12329)
Enumeration Date2026-05-21
Last Update Date2026-05-22
Business Address
Dr. BLAINE MICHAEL THEODOS
663 JORDAN ST
SHREVEPORT, LA 71101-4748
Phone number: 318-222-8892
Mailing Address
Dr. BLAINE MICHAEL THEODOS
663 JORDAN ST
SHREVEPORT, LA 71101-4748
Phone number: 318-222-8892
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