Provider Demographics
NPI:1114011152
Name:DUTCH PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:DUTCH PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRJAM
Authorized Official - Middle Name:MAASSEN
Authorized Official - Last Name:VEETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CERT MDT
Authorized Official - Phone:225-927-3000
Mailing Address - Street 1:2351 ENERGY DR
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2618
Mailing Address - Country:US
Mailing Address - Phone:225-927-3000
Mailing Address - Fax:225-927-3898
Practice Address - Street 1:10343 SIEGEN LN
Practice Address - Street 2:BLDG. 3 SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4979
Practice Address - Country:US
Practice Address - Phone:225-767-4440
Practice Address - Fax:225-767-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01436F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C986Medicare ID - Type UnspecifiedMEDICARE NO.