Active NPI
Mary Beth Churbock, PT
- Physical Therapist
- Lafayette, LA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 00325
- Practice address
- 308 Sidney Martin Rd
Room 174
Lafayette, LA 70507-4544 - Phone
- (337) 233-3665
- NPI assigned
- Jun 29, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 00325 | LA | Primary |
Addresses
Primary practice location
308 Sidney Martin Rd
Room 174
Lafayette, LA 70507-4544
Mailing address
2002 Johnson St
Suite 100
Jennings, LA 70546-3640
Phone (337) 824-4547
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00325 | LA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Center of Jefferson Davis Parish, Inc | Physical Therapist | Current | Accepting new patients |
| Lemoine Therapy Services of Cenla Inc | Physical Therapist | Past | Accepting new patients |
| Physical Therapy Clinic of Carencro LLC | Physical Therapist | Past | Accepting new patients |
Locations
204 E Saint Peter St
Carencro, LA 70520
Phone (337) 896-6685
1401 Church St
Jeanerette, LA 70544
Phone (337) 276-2803
2002 Johnson St
Ste 100
Jennings, LA 70546
Phone (337) 824-8287
105 Patriot St
Ste 201
Lafayette, LA 70508
Phone (337) 345-1957
4451 Nelson Rd
Lake Charles, LA 70605
Phone (337) 480-0027
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Jennings, LA
- NPI 1508971045
-
- Physical Therapist
- Mansura, LA
- NPI 1336242767
-
- Physical Therapist
- Carencro, LA
- NPI 1669557906
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435536000000",
"number": "1134501927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 JOHNSON ST",
"address_2": "SUITE 100",
"city": "JENNINGS",
"state": "LA",
"postal_code": "705463640",
"telephone_number": "337-824-4547",
"fax_number": "337-824-4548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 SIDNEY MARTIN RD",
"address_2": "ROOM 174",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705074544",
"telephone_number": "337-233-3665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHURBOCK",
"first_name": "MARY",
"middle_name": "BETH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-29",
"last_updated": "2015-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "00325",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lafayette, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.