Fundamental Therapy Llc

LBN: Fundamental Therapy Llc
Fundamental Therapy Llc is an health care organization with primary practice located at 311 N Main St , Picayune MS 39466-3313. The organization recently has only one registered license in Other Service Providers / Specialist, which is considered as the primary health care specialty. Fundamental Therapy Llc can be contacted via phone (601) 799-4065, or through Braddy, Sara Carr via phone (601) 916-8329.

Contact Information

Primary practice address
311 N Main St Picayune MS 39466-3313
Phone: (601) 799-4065
Fax: (601) 620-4117
Website:
Map and Directions
Authorized official contact:
Name: Braddy, Sara Carr MOTR/L
Phone: (601) 916-8329

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X OT2316 Mississippi

Profile Details

NPI number 1659796860
LBN Legal business name Fundamental Therapy Llc
DBA Doing business as
Authorized official Braddy, Sara Carr MOTR/L
Entity Organization
Organization subpart 1 No
Enumeration date Feb 25th, 2014
Last updated Jan 10th, 2015 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659796860 NPPES
Mississippi MEDICAID 05587048

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