Provider Demographics
NPI:1508971045
Name:THERAPY CENTER OF JEFFERSON DAVIS PARISH, INC
Entity Type:Organization
Organization Name:THERAPY CENTER OF JEFFERSON DAVIS PARISH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DUHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-824-4547
Mailing Address - Street 1:2002 JOHNSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3646
Mailing Address - Country:US
Mailing Address - Phone:337-824-4547
Mailing Address - Fax:337-824-4548
Practice Address - Street 1:2002 JOHNSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3646
Practice Address - Country:US
Practice Address - Phone:337-824-4547
Practice Address - Fax:337-824-4548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224Z00000X, 225100000X, 225200000X, 2255A2300X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CB91Medicare ID - Type UnspecifiedMEDICARE FACILITY #