Healthcare Provider Details

I. General information

NPI: 1649108614
Provider Name (Legal Business Name): SCOTT TERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 ONEAL LN
BATON ROUGE LA
70816-3204
US

IV. Provider business mailing address

5002 MOBILE DR
BATON ROUGE LA
70817-2341
US

V. Phone/Fax

Practice location:
  • Phone: 225-754-5188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number12094
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: