Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 1237827 | TX |
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1083034177 |
---|---|
Provider Name | Andrew Stout |
First Address | Lake Charles, LA 70607-7032 |
Second Address | Lake Charles, LA 70607-7032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 17/03/2018 |