Healthcare Provider Details

I. General information

NPI: 1508971045
Provider Name (Legal Business Name): THERAPY CENTER OF JEFFERSON DAVIS PARISH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 JOHNSON ST SUITE 100
JENNINGS LA
70546-3646
US

IV. Provider business mailing address

2002 JOHNSON ST SUITE 100
JENNINGS LA
70546-3646
US

V. Phone/Fax

Practice location:
  • Phone: 337-824-4547
  • Fax: 337-824-4548
Mailing address:
  • Phone: 337-824-4547
  • Fax: 337-824-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateLA
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateLA

VIII. Authorized Official

Name: MRS. ELISHA N DUHON
Title or Position: CO-OFFICE MANAGER
Credential:
Phone: 337-824-4547