Provider Demographics
| NPI: | 1063042166 |
|---|---|
| Name: | TULLAHOMA PEDIATRIC THERAPY, LLC |
| Entity type: | Organization |
| Organization Name: | TULLAHOMA PEDIATRIC THERAPY, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | LAURA |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | MILLER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 931-581-9018 |
| Mailing Address - Street 1: | 1282 TURKEY CREEK DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | TULLAHOMA |
| Mailing Address - State: | TN |
| Mailing Address - Zip Code: | 37388-4672 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 931-581-9018 |
| Mailing Address - Fax: | 931-623-6133 |
| Practice Address - Street 1: | 1282 TURKEY CREEK DR |
| Practice Address - Street 2: | |
| Practice Address - City: | TULLAHOMA |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 37388-4672 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 931-581-9018 |
| Practice Address - Fax: | 931-623-6133 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-01-17 |
| Last Update Date: | 2024-01-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Multi-Specialty |
