MEDICARE: DOWNTOWN PHYSICAL THERAPY AND INDUSTRIAL CENTER LLC

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	225100000X	Physical Therapist	02074	LA

General Provider Information

NPI Number	:	1255413480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNTOWN PHYSICAL THERAPY AND INDUSTRIAL CENTER LLC

Provider Business Mailing Address
First Line	:	16645 HIGHLAND RD
Second Line	:	SUITE L
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-6567
Country	:	US
Telephone Number	:	225-756-2722
Fax Number	:	225-756-4431

Provider Business Practice Location Address
First Line	:	16645 HIGHLAND RD
Second Line	:	SUITE L
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-6567
Country	:	US
Telephone Number	:	225-756-2722
Fax Number	:	225-756-4431

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCOTT MITCHELL LARSON
Credential	:	PT
Telephone Number	:	225-756-2722

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	05/21/2008

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