Provider Demographics
NPI:1336435387
Name:JOHNSON, JEREME BRIAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:JEREME
Middle Name:BRIAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2780
Mailing Address - Street 2:187 NINTH ST
Mailing Address - City:JENA
Mailing Address - State:LA
Mailing Address - Zip Code:71342-2780
Mailing Address - Country:US
Mailing Address - Phone:318-992-9200
Mailing Address - Fax:318-992-9279
Practice Address - Street 1:187 NINTH ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-2780
Practice Address - Country:US
Practice Address - Phone:318-992-9200
Practice Address - Fax:318-992-9279
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08028208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation