Provider Demographics
NPI:1568931269
Name:READY SET GEAUX THERAPY
Entity Type:Organization
Organization Name:READY SET GEAUX THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE BANGE
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, LOTR
Authorized Official - Phone:318-286-7650
Mailing Address - Street 1:522 OIL FIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71051-7909
Mailing Address - Country:US
Mailing Address - Phone:318-286-7650
Mailing Address - Fax:
Practice Address - Street 1:522 OIL FIELD RD
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:LA
Practice Address - Zip Code:71051-7909
Practice Address - Country:US
Practice Address - Phone:318-286-7650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency