1194836056 NPI number — THERAPY ZONE, LLC

Table of content: (NPI 1194836056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194836056 NPI number — THERAPY ZONE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY ZONE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LESLIE HAMMOND D.B.A. THERAPY ZONE
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194836056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7160 TCHULAHOMA
Provider Second Line Business Mailing Address:
BLD B-SUITE 4
Provider Business Mailing Address City Name:
SOUTHAVEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38671-9266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-349-2733
Provider Business Mailing Address Fax Number:
662-536-1849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7160 TCHULAHOMA
Provider Second Line Business Practice Location Address:
BLD B, SUITE 4
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-9266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-349-2733
Provider Business Practice Location Address Fax Number:
662-536-1849
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/ SPEECH LANG. PATHOLOGIST
Authorized Official Telephone Number:
662-349-2733

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  S2277 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7384169 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4019252 . This is a "BLUE CROSS/ BLUE SHEILD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 052625865 . This is a "BLUE CROSS/ BLUE SHEILD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09015269 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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