Healthcare Provider Details

I. General information

NPI: 1699658971
Provider Name (Legal Business Name): DAWSON TYLER WINDSOR PHYSICAL THERAPIST
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S CLEARVIEW PKWY
JEFFERSON LA
70121-1015
US

IV. Provider business mailing address

1201 S CLEARVIEW PKWY BLDG B
JEFFERSON LA
70121-1015
US

V. Phone/Fax

Practice location:
  • Phone: 504-734-1472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number11825
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: