SB Physical Therapy and Sports Rehab

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SB PHYSICAL THERAPY AND SPORTS REHAB

Practice address

12739 Highway 171 Ste B
Longville, LA 70652-5050

Phone

(337) 317-9290

Fax

(337) 725-4457

NPI assigned

May 8, 2018

Last updated

Oct 2, 2023By 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

Melody C Jackson

Title

Administrator

Phone

(337) 317-9290

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 3

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.

• Christopher Carl Jackson, PHYSICAL THERAPIST

  • Physical Therapist
  • Longville, LA
  • NPI 1972009041

  Single Specialty

  Medicare reassignment NPD
• Russell Warren Hearne, PT,DPT

  • Physical Therapist
  • Deridder, LA
  • NPI 1508369737
  NPD
• Sarah Elizabeth Ewing, PT, DPT

  • Physical Therapist
  • Longville, LA
  • NPI 1316857329
  NPD (past)

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1619466356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12739 HIGHWAY 171 STE B",
            "city": "LONGVILLE",
            "state": "LA",
            "postal_code": "706525050",
            "telephone_number": "337-317-9290",
            "fax_number": "337-725-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12739 HIGHWAY 171 STE B",
            "city": "LONGVILLE",
            "state": "LA",
            "postal_code": "706525050",
            "telephone_number": "337-317-9290",
            "fax_number": "337-725-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SB PHYSICAL THERAPY AND SPORTS REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-08",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MELODY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "337-317-9290"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Ewing, PT, DPT
• Christopher Carl Jackson, PHYSICAL THERAPIST
• Jeremy Romaine Leblanc
• Laura Ellen Neely, M.S., CCC-SLP
• Taylor Raymond
• South Beauregard Health Center, L.L.C.
• Kathy Lynne Tracy, MD
• David Vizinat, APRN FNP-C

• Physical Therapist in Longville, LA
• Providers in Longville, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; 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.