Organization
WKH PHYSICAL MEDICINE PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED THOMAS BEVILLE (VP PHYSICIAN NETWORK)
(318) 716-4891
Entity
Organization
Contact information
Practice address
1111 LINE AVE, SHREVEPORT, LA 71101-3841
(318) 716-4950
Mailing address
1111 LINE AVE, SHREVEPORT, LA 71101-3841
(318) 716-4950
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
09/03/2025
Last updated
09/22/2025
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