Julian Craig McCulloch, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-0307 Issued in LA

Practice address

4971 Groom Rd
Baker, LA 70714-3145

Phone

(225) 775-7051

Fax

(225) 774-7244

NPI assigned

Jan 23, 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

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 and National Provider Directory roles.

• Baker Physical Therapy Clinic

  • Rehabilitation Clinic/Center
  • Baker, LA
  • NPI 1770628141
  NPD (past) Authorized official

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376697607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4971 GROOM RD",
            "city": "BAKER",
            "state": "LA",
            "postal_code": "707143145",
            "telephone_number": "225-775-7051",
            "fax_number": "225-774-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4971 GROOM RD",
            "city": "BAKER",
            "state": "LA",
            "postal_code": "707143145",
            "telephone_number": "225-775-7051",
            "fax_number": "225-774-7244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOCH",
        "first_name": "JULIAN",
        "middle_name": "CRAIG",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "PT-0307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "23651",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madelyn Antle Martin, LMSW
• Gerrick Matthews
• Emmanuel Mbang
• Daris McCorkle
• Ashley McCray
• MCMS, LLC
• Med-Van Transit LLC
• Mercy Medical Transportation
• Mercy Primary Care Home Visits
• Junias Mesidor

• All providers in Baker, LA
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.