Provider Demographics
NPI:1699152074
Name:BLUE LAGUNE THERAPY, INC
Entity type:Organization
Organization Name:BLUE LAGUNE THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIASOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-376-1343
Mailing Address - Street 1:1115 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493
Mailing Address - Country:US
Mailing Address - Phone:281-712-4835
Mailing Address - Fax:832-437-5709
Practice Address - Street 1:1115 AVENUE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2465
Practice Address - Country:US
Practice Address - Phone:281-712-4835
Practice Address - Fax:832-437-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty