Provider Demographics
NPI:1851496129
Name:UNITED THERAPISTS OF LOUISIANA L.L.C
Entity Type:Organization
Organization Name:UNITED THERAPISTS OF LOUISIANA L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:M
Authorized Official - Last Name:NJALLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:318-941-5006
Mailing Address - Street 1:1900 FALSE RIVER DRIVE
Mailing Address - Street 2:STE #1
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760
Mailing Address - Country:US
Mailing Address - Phone:318-941-5006
Mailing Address - Fax:318-941-5007
Practice Address - Street 1:344 MISSION DRIVE
Practice Address - Street 2:
Practice Address - City:SIMMESPORT
Practice Address - State:LA
Practice Address - Zip Code:71369
Practice Address - Country:US
Practice Address - Phone:318-941-5006
Practice Address - Fax:318-941-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04007R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1123846Medicaid
LA5CB55Medicare ID - Type Unspecified