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Contact Information

FUNDAMENTAL THERAPY LLC
311 N MAIN ST
PICAYUNE, MS39466-3313
 Phone: 601-799-4065
 Fax: 601-620-4117
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for FUNDAMENTAL THERAPY LLC

NPI Number 1659796860
LBN Legal business name FUNDAMENTAL THERAPY LLC
Authorized official SARA BRADDY - (OCCUPATIONAL THERAPIST)
Entity Organization
Organization subpart 1 No
Enumeration date 02/25/2014
Last updated 01/10/2015 - About 11 years ago
Identifiers
MS License # OT2316
MS Medicaid 05587048
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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