Provider Demographics
NPI:1871151399
Name:STALLINGS, AMY LAURA (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LAURA
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LAURA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6505 BAYOU CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-7037
Mailing Address - Country:US
Mailing Address - Phone:318-201-1754
Mailing Address - Fax:318-442-3137
Practice Address - Street 1:1135 EXPRESSWAY DR STE 100A
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6666
Practice Address - Country:US
Practice Address - Phone:318-442-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAO4O332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic