Provider Demographics
NPI:1013218189
Name:DWIGHT, AUSTEN CHASE (DPT)
Entity Type:Individual
Prefix:
First Name:AUSTEN
Middle Name:CHASE
Last Name:DWIGHT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2802
Mailing Address - Country:US
Mailing Address - Phone:985-630-4489
Mailing Address - Fax:
Practice Address - Street 1:304 E BOSTON ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2802
Practice Address - Country:US
Practice Address - Phone:985-630-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist