Jeremy Stillwell, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

02441 Issued in LA

Practice address

217 Sam Houston Jones Pkwy
Ste 103
Lake Charles, LA 70611-5644

Phone

(337) 217-0997

Fax

(337) 217-0998

NPI assigned

Feb 28, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285632000000",
    "number": "1174650659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 OAK PARK BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017864",
            "telephone_number": "337-310-5116",
            "fax_number": "337-310-5118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 SAM HOUSTON JONES PKWY",
            "address_2": "STE 103",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706115644",
            "telephone_number": "337-217-0997",
            "fax_number": "337-217-0998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILLWELL",
        "first_name": "JEREMY",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2010-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "02441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548928",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; 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.