# BEAUREGARD PHYSICAL THERAPY CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003080367
- **Authorized official:** JAMEY JEROME JOHNSON MPT (OWNER/PRESIDENT/PHYSICAL THERAPIST)
- **Authorized official phone:** (337) 462-6097

## Contact information

- **Practice address:** 309 S WASHINGTON ST, DERIDDER, LA 70634-4861
- **Practice address phone:** (337) 462-6097
- **Practice address fax:** (337) 462-0531
- **Mailing address:** 309 S WASHINGTON ST, DERIDDER, LA 70634-4861
- **Mailing address phone:** (337) 462-6097
- **Mailing address fax:** (337) 462-0531

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2008
- **Last updated:** 07/18/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | PT06472 | LA PHYSICAL THERAPY BOARD | LA |