Healthcare Provider Details

I. General information

NPI: 1891794491
Provider Name (Legal Business Name): JACKSON PARISH THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 COMMERCE ST
RUSTON LA
71270-6659
US

IV. Provider business mailing address

PO BOX 2846
RUSTON LA
71273-2846
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-8994
  • Fax: 318-224-7094
Mailing address:
  • Phone: 318-224-8994
  • Fax: 318-224-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number03825R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JERRY V YARBOROUGH
Title or Position: OWNER
Credential: PT, DPT
Phone: 318-224-8994