MEDICARE: MR. PATRICK SCOTT PITARRO MPT

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	06344	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06344	OTHER	LA	LOUISIANA STATE LICENSE

General Provider Information

NPI Number	:	1740578442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK SCOTT PITARRO MPT

Provider Business Mailing Address
First Line	:	31985 LA HIGHWAY 16
Second Line	:	SUITE C
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-1462
Country	:	US
Telephone Number	:	225-791-7114
Fax Number	:	225-791-7118

Provider Business Practice Location Address
First Line	:	31985 LA HIGHWAY 16
Second Line	:	SUITE C
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-1462
Country	:	US
Telephone Number	:	225-791-7114
Fax Number	:	225-791-7118

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

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	07/14/2011

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