Tracie Pendarvis

NPI #1215200191 in Bossier City, Louisiana

Provider Information

NPI Number: 1215200191
Entity Type: Individual
Name: Tracie Pendarvis
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Developmental Therapist
Enumeration Date: Feb 22, 2012
Last Updated: Feb 22, 2012

Practice Location

Address: 5604 PAMPUS LN
City: Bossier City
State: Louisiana
ZIP Code: 71112-4951
Phone: (318) 458-1834

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Developmental Therapist	222Q00000X	Primary

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