Organization
PG THERAPY LLC
Active
Parent organization
PERSEVERE CORP
Other names
FYZICAL Therapy & Balance Centers
Organization subpart
Yes
Provider details
NPI number
Legal business name
PERSEVERE CORP
Authorized official
MR. PATRICK JOHN GLEESON CISSP (GENERAL MANAGER)
(202) 455-6605
Entity
Organization
Contact information
Practice address
16172 AIRLINE HWY STE B, PRAIRIEVILLE, LA 70769-4212
(225) 255-4020
(225) 255-4024
Mailing address
9029 JEFFERSON HWY STE D-104, NEW ORLEANS, LA 70123-3500
(225) 255-4020
(225) 255-4024
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100125742
PEOPLESHEALTH
—
01
—
187466
UNITEDHEALTHCARE (OPTUM)
—
01
—
5281
CAQH
—
01
—
8819519
AETNA
—
Enumeration date
05/26/2022
Last updated
05/02/2023
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