=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871785105
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IAN DEXTER KHO PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2007
-----------------------------------------------------
Last Update Date | 08/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 RAGAN DR
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71303-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-443-6726
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 RAGAN DR
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71303-2230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-443-6726
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251C2600X
-----------------------------------------------------
Taxonomy Name | Cardiopulmonary Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2251E1200X
-----------------------------------------------------
Taxonomy Name | Ergonomics Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2251E1300X
-----------------------------------------------------
Taxonomy Name | Clinical Electrophysiology Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 2251G0304X
-----------------------------------------------------
Taxonomy Name | Geriatric Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 2251H1200X
-----------------------------------------------------
Taxonomy Name | Hand Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 2251H1300X
-----------------------------------------------------
Taxonomy Name | Human Factors Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 2251N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 04778F
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------