Provider Demographics
NPI:1942871900
Name:GEAUX PTLA LLC
Entity Type:Organization
Organization Name:GEAUX PTLA LLC
Other - Org Name:UNLIMITED PERFORMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENGLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:225-610-4960
Mailing Address - Street 1:1405 W PRIEN LAKE RD STE A
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 STE A
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty