Provider Demographics
NPI:1740246875
Name:HUTSON, COURTNEY L (PT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:HUTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8448 SIEGEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1938
Mailing Address - Country:US
Mailing Address - Phone:225-767-8182
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:8448 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1938
Practice Address - Country:US
Practice Address - Phone:225-767-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H611Medicare ID - Type Unspecified