Provider Demographics
NPI:1699232165
Name:FOUNDATIONS THERAPY LLC
Entity type:Organization
Organization Name:FOUNDATIONS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:SHULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-821-0724
Mailing Address - Street 1:36 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-2100
Mailing Address - Country:US
Mailing Address - Phone:573-821-0274
Mailing Address - Fax:
Practice Address - Street 1:536 S BUSINESS HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1438
Practice Address - Country:US
Practice Address - Phone:573-821-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty