Provider Demographics
NPI:1255413480
Name:DOWNTOWN PHYSICAL THERAPY AND INDUSTRIAL CENTER LLC
Entity type:Organization
Organization Name:DOWNTOWN PHYSICAL THERAPY AND INDUSTRIAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-756-2722
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H587BC96Medicare PIN