1730552571 NPI number — CONSOLIDATED THERAPIES, LLC

Table of content: (NPI 1730552571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730552571 NPI number — CONSOLIDATED THERAPIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSOLIDATED THERAPIES, 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:
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:
1730552571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5699 GETWELL RD
Provider Second Line Business Mailing Address:
BUILDING H, SUITE 1
Provider Business Mailing Address City Name:
SOUTHAVEN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38672-6347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-470-4187
Provider Business Mailing Address Fax Number:
662-391-4236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5699 GETWELL RD
Provider Second Line Business Practice Location Address:
BUILDING H, SUITE 1
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38672-6347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-470-4187
Provider Business Practice Location Address Fax Number:
662-391-4236
Provider Enumeration Date:
11/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MITIAS
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
HUGGINS
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
901-275-0896

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A2851 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: S3893 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04852570 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04729074 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".