Beauregard Physical Therapy Clinic, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BEAUREGARD PHYSICAL THERAPY CLINIC, INC

Practice address

309 S Washington St
Deridder, LA 70634-4861

Phone

(337) 462-6097

Fax

(337) 462-0531

NPI assigned

Apr 17, 2008

Last updated

Jul 18, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jamey Jerome Johnson, MPTNPI 1881653632

Title

Owner/President/Physical Therapist

Phone

(337) 462-6097

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 4

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.

• Jamey Johnson, PT

  • Physical Therapist
  • Deridder, LA
  • NPI 1881653632
  Medicare reassignment Care Compare group Authorized official
• Mason Shaw, DPT

  • Physical Therapist
  • Deridder, LA
  • NPI 1245800051
  Medicare reassignment Care Compare group
• Rebecca Kohara Broussard, P.T., D.P.T.

  • Physical Therapist
  • Deridder, LA
  • NPI 1720301187
  NPD (past)
• Kathern Sue Hollifield, R.P.T.

  • Physical Therapist
  • Deridder, LA
  • NPI 1982835013
  NPD (past)

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

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1003080367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 S WASHINGTON ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344861",
            "telephone_number": "337-462-6097",
            "fax_number": "337-462-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S WASHINGTON ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344861",
            "telephone_number": "337-462-6097",
            "fax_number": "337-462-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUREGARD PHYSICAL THERAPY CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-17",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JAMEY",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "OWNER/PRESIDENT/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "337-462-6097",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA PHYSICAL THERAPY BOARD",
            "identifier": "PT06472",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beauregard Memorial Hospital Homecare, LLC (Beauregard Home Health)
• Beauregard Memorial Hospital Medical Staff Services
• Beauregard Parish School Board
• Beauregard Parish School Board
• Beauregard Pediatric Center, LLC
• Beauregard Physician Group, LLC
• Beauregard Physician Services LLC
• Beauregard Surgery Center, LLC (David J. Brown, M.D.)
• Beauregard Urgent Care Center, LLC
• Beauregard Urology Center, LLC (Chuen K. Kwok, M.D.)

• Physical Therapist in Deridder, LA
• Providers in Deridder, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.