Provider Demographics
NPI:1336347350
Name:DUTCHTOWN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DUTCHTOWN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
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:225-744-3631
Mailing Address - Street 1:36501 MISSION ST STE A
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3192
Mailing Address - Country:US
Mailing Address - Phone:225-744-3631
Mailing Address - Fax:225-744-3647
Practice Address - Street 1:36501 MISSION ST STE A
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3192
Practice Address - Country:US
Practice Address - Phone:225-744-3631
Practice Address - Fax:225-744-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy