Provider Demographics
NPI:1407938616
Name:LARSON, SCOTT MITCHELL (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MITCHELL
Last Name:LARSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16645 HIGHLAND RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6567
Mailing Address - Country:US
Mailing Address - Phone:225-756-2722
Mailing Address - Fax:225-756-4431
Practice Address - Street 1:16645 HIGHLAND RD
Practice Address - Street 2:SUITE L
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6567
Practice Address - Country:US
Practice Address - Phone:225-756-2722
Practice Address - Fax:225-756-4431
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H587BC96Medicare PIN