Active NPI
Joseph M McCulloch Jr., P.T.
- Physical Therapist
- Shreveport, LA
National Provider Identifier
1528081908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 1450 Claiborne Ave
Lsuhsc-School of Allied Health Professionals
Shreveport, LA 71103-4204 - Phone
- (318) 813-2970
- Fax
- (318) 813-2981
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
1450 Claiborne Ave
Lsuhsc-School of Allied Health Professionals
Shreveport, LA 71103-4204
Mailing address
1501 Kings Hwy
Lsuhsc-Allied Health Clinics
Shreveport, LA 71103-4228
Phone (318) 813-2970
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174173 | Medicaid | LA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480204800000",
"number": "1528081908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"address_2": "LSUHSC-ALLIED HEALTH CLINICS",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-813-2970",
"fax_number": "318-813-2981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 CLAIBORNE AVE",
"address_2": "LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONALS",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034204",
"telephone_number": "318-813-2970",
"fax_number": "318-813-2981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOCH",
"first_name": "JOSEPH",
"middle_name": "M",
"name_suffix": "Jr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2016-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174173",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.