# WKH PHYSICAL MEDICINE PHYSICIANS

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

## Provider details

- **NPI number:** 1861372633
- **Authorized official:** JARED THOMAS BEVILLE (VP PHYSICIAN NETWORK)
- **Authorized official phone:** (318) 716-4891

## Contact information

- **Practice address:** 1111 LINE AVE, SHREVEPORT, LA 71101-3841
- **Practice address phone:** (318) 716-4950
- **Mailing address:** 1111 LINE AVE, SHREVEPORT, LA 71101-3841
- **Mailing address phone:** (318) 716-4950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2025
- **Last updated:** 09/22/2025