NPIMap

Organization Active NPI

Sog Physical Therapy

  • Multi-Specialty Clinic/Center
  • Tupelo, MS
National Provider Identifier
1902361660
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SOG PHYSICAL THERAPY
Practice address
1211 S Gloster St Ste C
Tupelo, MS 38801-6535
Phone
(662) 767-4200
Fax
(767) 420-4662
NPI assigned
Feb 7, 2019
Last updated
Sep 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Authorized official

Name
Thomas Luster
Title
Ceo
Phone
(662) 767-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

1211 S Gloster St Ste C
Tupelo, MS 38801-6535

Mailing address

1211 S Gloster St
Tupelo, MS 38801-6546
Phone (662) 432-1523

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190724000229 MS Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1850627209 Receives reassigned benefits from 23 practitioners
Practice locations: Oxford, MS; Tupelo, MS; Starkville, MS
O20201109002543 MS DME Supplier - Independently-Practicing Occupational TherapistDME Supplier - Independently-Practicing Physical Therapist 1850627209 Practice locations: Tupelo, MS

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

723 Concordia Ave
Ste 101
Oxford, MS 38655
Phone (662) 432-1523

1211 S Gloster St
Ste C
Tupelo, MS 38801
Phone (662) 432-1523

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1549497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1902361660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 S GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016546",
            "telephone_number": "662-432-1523",
            "fax_number": "662-432-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 S GLOSTER ST STE C",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016535",
            "telephone_number": "662-767-4200",
            "fax_number": "767-420-4662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOG PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-07",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "LUSTER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-767-4200"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.