MEDICARE: ANDREW STOUT PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251N0400X	Neurology Physical Therapist	09335R	LA

General Provider Information

NPI Number	:	1083034177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW STOUT PT, DPT

Provider Business Mailing Address
First Line	:	3564 AVALON PARK E BLVD STE 1
Second Line	:	UNIT # A889
City	:	ORLANDO
State	:	FL
Zip	:	32828
Country	:	US
Telephone Number	:	318-542-7154
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 SUNDALE DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-7032
Country	:	US
Telephone Number	:	337-405-8823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	10/14/2022

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