Provider Demographics
NPI:1225446669
Name:FOUNDATION THERAPY LLC
Entity type:Organization
Organization Name:FOUNDATION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:940-210-5836
Mailing Address - Street 1:1116 HALSELL ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-3000
Mailing Address - Country:US
Mailing Address - Phone:940-393-5575
Mailing Address - Fax:940-210-0568
Practice Address - Street 1:1116 HALSELL ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-3000
Practice Address - Country:US
Practice Address - Phone:940-393-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172223261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy