1649816588 NPI number — EMBODIMENT THERAPY LLC

Table of content: REBECCA LEMMEL LAT, ATC (NPI 1720432750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649816588 NPI number — EMBODIMENT THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBODIMENT THERAPY 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:
Provider Other Organization Name Type Code:
6
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:
1649816588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 423
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RONAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59864-0423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-368-5298
Provider Business Mailing Address Fax Number:
406-571-4008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63917 US HIGHWAY 93
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59864-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-368-5298
Provider Business Practice Location Address Fax Number:
406-571-4008
Provider Enumeration Date:
11/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CHURCH
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
ALLISON
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
865-368-5298

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1578063616 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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