DWIGHT A TIETJEN

SHREVEPORT, LA
NPI1902001076
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225100000X Physical Therapist
(Licence: LA  PT118)
Enumeration Date2007-06-19
Last Update Date2007-07-08
Business Address
Mr. DWIGHT A TIETJEN P.T.
4801 CRESCENT DR
SHREVEPORT, LA 71106-1807
Phone number: 318-464-0553
Mailing Address
Mr. DWIGHT A TIETJEN P.T.
4801 CRESCENT DR
SHREVEPORT, LA 71106-1807
Phone number: 318-464-0553
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