Superior Spine and Sports Physical Therapy Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SUPERIOR SPINE AND SPORTS PHYSICAL THERAPY INC

Practice address

5750 Lake Street
Suite 100
Lake Charles, LA 70605

Phone

(337) 513-7107

NPI assigned

Jan 12, 2023

Organization subpart

No

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

Authorized official

Name

Kourtney Ellis, DPTNPI 1093264269

Title

Co-Owner

Phone

(337) 513-7107

Specialties & licenses 1

Addresses

Other names 1

• S3PT Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kourtney Kober Ellis, D.P.T.

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1093264269
  Medicare reassignment Care Compare group Authorized official
• Jared Trent Landry, D.P.T.

  • Physical Therapist
  • Lake Charles, LA
  • NPI 1013394907
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1619681772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 LAKE STREET",
            "address_2": "SUITE 100",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 LAKE STREET",
            "address_2": "SUITE 100",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70605",
            "telephone_number": "337-513-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR SPINE AND SPORTS PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KOURTNEY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "337-513-7107",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "S3PT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prasanna Sugathan, M.D.
• Marilyn Sullins, R.D.
• Lisa Sullivan
• Natalia Sumodjo, M.S., LAT, ATC, CES
• Sunny Days Home Care 2 LLC
• Surge LLC
• Surgical Anesthesia of Baton Rouge LLC
• Surgical Artistry
• Surgicare of Lake Charles LLC
• Susan W. Boyd, MD, LLC

• 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 Jan 12, 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.