Core Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

09009R Issued in LA

Legal business name

CORE PHYSICAL THERAPY, LLC

Practice address

4616 Highway 84 W
Vidalia, LA 71373

Phone

(318) 336-5400

Fax

(318) 336-8621

NPI assigned

Jan 9, 2015

Last updated

Jan 31, 2024By 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

Milah McGraw

Title

Bus Manager

Phone

(318) 336-5400

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 4

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.

• Blakelynn Colclasure Bass, DPT

  • Physical Therapist
  • Vidalia, LA
  • NPI 1629693601

  Physical Therapy

  Medicare reassignment Care Compare group NPD
• Jessica Marling Clayton, DPT

  • Orthopedic Physical Therapist
  • Vidalia, LA
  • NPI 1154596377
  Medicare reassignment Care Compare group NPD
• Haley Sharp Campbell, DPT

  • Physical Therapist
  • Natchez, MS
  • NPI 1003648429

  LA

  Medicare reassignment Care Compare group NPD
• Ellen Bairnsfather Upton, PTA

  • Physical Therapy Assistant
  • Flowood, MS
  • NPI 1245870666
  NPD (past)

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1548659840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4616 HIGHWAY 84 W",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733357",
            "telephone_number": "318-336-5400",
            "fax_number": "318-336-8621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4616 HIGHWAY 84 W",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "71373",
            "telephone_number": "318-336-5400",
            "fax_number": "318-336-8621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-09",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "MCGRAW",
        "authorized_official_first_name": "MILAH",
        "authorized_official_title_or_position": "BUS MANAGER",
        "authorized_official_telephone_number": "318-336-5400"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "LA",
            "license": "09009R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05702398",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236280",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krystle Coleman
• Alexius Coley
• Concordia Parish Hospital Service District Number One (Trinity Medical Vidalia Clinic)
• Concordia Parish School Board
• Concordia Parish School Board
• Minnie Joyce Crawford, L.P.C., L.M.F.T.
• Alison M Cupit, SPEECH PATHOLOGIST
• Quionne Dabney
• Shonte' Patrice Daniels
• David Alan Timm (Pediatric & Adolescent Clinic)

• Physical Therapy Clinic/Center in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Physical Therapy Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.