Provider Demographics
NPI:1437300647
Name:SPENGLER, GRETA SUSANNA (DPT)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:SUSANNA
Last Name:SPENGLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GRETA
Other - Middle Name:SUSANNA
Other - Last Name:SPENGLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:1405 W PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8391
Mailing Address - Country:US
Mailing Address - Phone:337-245-1537
Mailing Address - Fax:337-570-1213
Practice Address - Street 1:1405 W PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8391
Practice Address - Country:US
Practice Address - Phone:337-245-1537
Practice Address - Fax:337-570-1213
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07975R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1V6112Medicaid
LA07975ROtherLOUISIANA BOARD OF PHYSICAL THERAPY
GA405452666DMedicaid
GA405452666CMedicaid
GA405452666CMedicaid