Lake Charles Sports & Rehab

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LAKE CHARLES SPORTS & REHAB

Practice address

4150 Nelson Rd Ste 1
Lake Charles, LA 70605-4148

Phone

(337) 824-5488

NPI assigned

Mar 18, 2021

Last updated

Mar 22, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Natalie Walker

Title

Executive Administrator

Phone

(337) 824-5488

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 16

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.

• Cullen Ballard

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1891674628
  Medicare reassignment Care Compare group NPD
• Raymond E Prince Jr., DPT

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1245259290
  Medicare reassignment Care Compare group NPD
• Seth Matthew Boullion, DPT

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1922983923
  Medicare reassignment NPD
• Brandon Joseph Broussard, DPT

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1730704073
  Medicare reassignment NPD
• Matthew Quinn Ezernack

  • Physical Medicine & Rehabilitation Physician
  • Lake Charles, LA
  • NPI 1912699547

  Physical Therapist

  Medicare reassignment NPD
• David M Frank, DPT

  • Physical Therapist
  • Crowley, LA
  • NPI 1629818661
  Medicare reassignment NPD
• Scott James Meche, OT

  • Occupational Therapist
  • Lake Charles, LA
  • NPI 1245218122
  Medicare reassignment NPD
• Ethan Rapp, DPT

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1366279903
  Medicare reassignment NPD
• Madeline Stringfellow, DPT

  • Physical Therapist
  • Lafayette, LA
  • NPI 1053045971
  Medicare reassignment NPD
• Mitchell Royce Talley, DPT

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1912343120
  Medicare reassignment NPD
• Jacob P Hebert, DPT

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1134058654
  Medicare reassignment
• Roberta Boone, PT

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1164197562
  NPD

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

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1194301317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 ELTON RD STE I",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705464100",
            "telephone_number": "337-824-5488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 NELSON RD STE 1",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054148",
            "telephone_number": "337-824-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CHARLES SPORTS & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-18",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "NATALIE",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR",
        "authorized_official_telephone_number": "337-824-5488"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Charles Memorial Heart and Vascular Center (Heart & Vascular Center)
• Lake Charles Pharmaceutical Supply Company LLC (Medical Plaza Pharmacy)
• Lake Charles Primary Care and Wellness
• Lake Charles Rheumatology LLC
• Lake Charles Senior Care Clinic LLC
• Lake Charles Urgent Care
• Lake Charles Urgent Care
• Lake Physical Therapy, LLC
• Lake Wellness Center, LLC
• Lakeshore Medic Pharmacy

• 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 Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.