Ethan Loftin, DPT

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

7839 Issued in LA

Practice address

1311 Gause Blvd
Slidell, LA 70458-3015

Phone

(985) 649-6577

Fax

(985) 649-7615

NPI assigned

Aug 13, 2024

Last updated

Aug 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellness Physical Therapy of Slidell, LLCGroup PAC ID 0840380523, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellness Physical Therapy of Slidell, LLC

  • Physical Therapist
  • Slidell, LA
  • NPI 1184810426
  Medicare reassignment Care Compare group
• Sports Medicine LTD

  • Physical Therapist
  • Pass Christian, MS
  • NPI 1184652737
  NPD (past)
• Wellness Physical Therapy of Diamondhead

  dba Wellness PT of Diamondhead

  • Physical Therapy Clinic/Center
  • Pass Christian, MS
  • NPI 1598001307

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1053142885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 GAUSE BLVD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704583015",
            "telephone_number": "985-649-6577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 GAUSE BLVD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704583015",
            "telephone_number": "985-649-6577",
            "fax_number": "985-649-7615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1053 Tina Ladner Vic Faye Rd",
            "address_purpose": "LOCATION",
            "city": "Pass Christian",
            "state": "MS",
            "postal_code": "395718920",
            "country_code": "US",
            "telephone_number": "228-255-5151",
            "fax_number": "985-228-5055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOFTIN",
        "first_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "LA",
            "license": "7839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lmchh PCP LLC
• Ann Roussel Lobello, MD
• Ebony Lockett
• Lisa Ann Loescher, DDS
• Madelyn Leslie Loescher, DDS
• Garrett Logan, DPT
• William Jeffrey Long, MD
• Daniela P Lopez, PA
• Louisiana Anesthesia Partners, LLC
• Louisiana CVS Pharmacy LLC (CVS Pharmacy #07192)

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Slidell, LA
• Providers in Slidell, LA by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.