LUCIAN THACKER

SHREVEPORT, LA
NPI1922764265
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: LA  A10795R)
Enumeration Date2021-11-10
Last Update Date2021-11-10
Business Address
LUCIAN THACKER PTA
510 E STONER AVE
SHREVEPORT, LA 71101-4243
Phone number: 318-221-8411
Mailing Address
LUCIAN THACKER PTA
153 CRANDON LN
HAUGHTON, LA 71037-9753
Phone number: 318-550-1007
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