Healthcare Provider Details

I. General information

NPI: 1083034177
Provider Name (Legal Business Name): ANDREW STOUT PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 SUNDALE DR
LAKE CHARLES LA
70607-7032
US

IV. Provider business mailing address

3564 AVALON PARK E BLVD STE 1 UNIT # A889
ORLANDO FL
32828
US

V. Phone/Fax

Practice location:
  • Phone: 337-405-8823
  • Fax:
Mailing address:
  • Phone: 318-542-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number09335R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: