1457125940 NPI number — ARCH PHYSICAL THERAPY & WELLNESS LLC

Table of content: MONIKA E. KIELTYKA FNP (NPI 1013361641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457125940 NPI number — ARCH PHYSICAL THERAPY & WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCH PHYSICAL THERAPY & WELLNESS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457125940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 OAKWOOD TRACE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71106-8314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-284-2956
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7591 FERN AVE STE 1203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-828-2972
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SHASTA
Authorized Official First Name:
ARCHNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
614-284-2956

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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