Provider Demographics
NPI:1477849768
Name:CARGILL, DAVID JASON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JASON
Last Name:CARGILL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 RHODA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4137
Mailing Address - Country:US
Mailing Address - Phone:225-636-6418
Mailing Address - Fax:
Practice Address - Street 1:4343 RHODA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4137
Practice Address - Country:US
Practice Address - Phone:225-636-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist