Provider Demographics
NPI:1134867203
Name:PG THERAPY LLC
Entity type:Organization
Organization Name:PG THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GLEESON
Authorized Official - Suffix:
Authorized Official - Credentials:CISSP
Authorized Official - Phone:202-455-6605
Mailing Address - Street 1:9029 JEFFERSON HWY STE D-104
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3500
Mailing Address - Country:US
Mailing Address - Phone:225-255-4020
Mailing Address - Fax:225-255-4024
Practice Address - Street 1:16172 AIRLINE HWY STE B
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4212
Practice Address - Country:US
Practice Address - Phone:225-255-4020
Practice Address - Fax:225-255-4024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSEVERE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5281OtherCAQH
8819519OtherAETNA
100125742OtherPEOPLESHEALTH
187466OtherUNITEDHEALTHCARE (OPTUM)