=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336347350
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUTCHTOWN PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13053 HWY. 73 STE. B
-----------------------------------------------------
City | GEISMAR
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70734-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-744-3631
-----------------------------------------------------
Fax | 225-744-3647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13053 HWY. 73 STE. B
-----------------------------------------------------
City | GEISMAR
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70734-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-744-3631
-----------------------------------------------------
Fax | 225-744-3647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SCOTT MITCHELL LARSON
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 225-756-2722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------