NPIMap

Organization Active NPI

Sports Orthopedic & Spine Therapy of Louisiana, LLC

  • Physical Therapy Clinic/Center
  • Haughton, LA
National Provider Identifier
1104393743
Registry record updated Nov 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SPORTS ORTHOPEDIC & SPINE THERAPY OF LOUISIANA, LLC
Practice address
169 Bent Tree Loop
Haughton, LA 71037-9085
Phone
(318) 745-9168
NPI assigned
Nov 1, 2018
Last updated
Nov 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2018

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

Authorized official

Name
Mark Green, PTNPI 1811123862
Title
Owner-Manager
Phone
(318) 745-9168

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

169 Bent Tree Loop
Haughton, LA 71037-9085

Mailing address

169 Bent Tree Loop
Haughton, LA 71037-9085
Phone (318) 745-9168

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541030400000",
    "number": "1104393743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 BENT TREE LOOP",
            "city": "HAUGHTON",
            "state": "LA",
            "postal_code": "710379085",
            "telephone_number": "318-745-9168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 BENT TREE LOOP",
            "city": "HAUGHTON",
            "state": "LA",
            "postal_code": "710379085",
            "telephone_number": "318-745-9168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS ORTHOPEDIC & SPINE THERAPY OF LOUISIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-01",
        "last_updated": "2018-11-01",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER-MANAGER",
        "authorized_official_telephone_number": "318-745-9168",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Haughton, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.