Provider Demographics
NPI:1902225824
Name:CALLABA THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:CALLABA THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-540-7226
Mailing Address - Street 1:928 TERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2650
Mailing Address - Country:US
Mailing Address - Phone:337-540-7226
Mailing Address - Fax:337-475-0150
Practice Address - Street 1:134 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5702
Practice Address - Country:US
Practice Address - Phone:337-540-7226
Practice Address - Fax:337-475-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT04405261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1068683Medicaid
LA1068683Medicaid