Jessica Granger Clark
Individual provider Active NPI Physical Therapist · Ruston, LA
NPI 1942864582 · NPPES record last updated Mar 25, 2025
Key facts
- NPI
- 1942864582
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 9612 (SC)
- Practice address
- 1701 Commerce St
Ruston, LA 71270-6659 - Phone
- (318) 224-8994
- NPI assigned
- Apr 29, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jackson Parish Therapy Center, LLC
Practice addresses (Care Compare)
523 E 6TH St
El Dorado, AR 71730-4007
Phone (870) 201-2222
900 Pershing Hwy
Jonesboro, LA 71251-2046
Phone (318) 259-9899
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA, AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200611002411 | LA | Practitioner - Physical Therapist in Private Practice | 4385066786 | Reassigns benefits to 2 organizations |
| I20250327003997 | AR | Practitioner - Physical Therapist in Private Practice | 4385066786 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therateam Outpatient Services, LLC | Physical Therapist | Current |
Accepting new patients |
| Jackson Parish Therapy Center LLC | Physical Therapist | Current |
Accepting new patients |
Locations
523 E 6th St
El Dorado, AR 71730
Phone (870) 201-2222
4615 Highway 80
Ste 9
Haughton, LA 71037
Phone (318) 518-0548
900 Pershing Hwy
Jonesboro, LA 71251
Phone (318) 224-8994
1701 Commerce St
Ruston, LA 71270
Phone (318) 224-8994
6723 Pines Rd
Ste 112
Shreveport, LA 71129
Phone (318) 562-3944
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9612 | SC | Yes |
Addresses
Primary practice location
1701 Commerce St
Ruston, LA 71270-6659
Mailing address
1110 Highway 556
Choudrant, LA 71227-9790
Other providers in Ruston, LA
- Choosing Change Counseling
- Theresa Cearley Christian
- Kathryn W Claborn
- Amanda M Clark
- Barbara Jean Clark
- Danny Clay
- CLHG-Ruston LLC
- CLHG-Ruston LLC
- CLHG-Ruston LLC
- CLHG-Ruston LLC
All providers in Ruston, LA · Physical Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.