Provider Demographics
NPI:1811418999
Name:BOUDREAUX, SCOTT W (DPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:BOUDREAUX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52068
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2068
Mailing Address - Country:US
Mailing Address - Phone:337-981-6464
Mailing Address - Fax:337-981-6440
Practice Address - Street 1:1700 KALISTE SALOOM RD BLDG 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6186
Practice Address - Country:US
Practice Address - Phone:337-534-8601
Practice Address - Fax:337-210-2098
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2456024Medicaid