Provider Demographics
NPI:1528684370
Name:THE UNRULY TONGUE MYOFUNCTIONAL THERAPY LLC
Entity type:Organization
Organization Name:THE UNRULY TONGUE MYOFUNCTIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MYOFUNTIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THRESSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOGLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-919-0515
Mailing Address - Street 1:1125 NW BLUEGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647
Mailing Address - Country:US
Mailing Address - Phone:208-991-0515
Mailing Address - Fax:
Practice Address - Street 1:1125 NW BLUEGRASS CIR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647
Practice Address - Country:US
Practice Address - Phone:208-991-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty