Provider Demographics
NPI:1194376657
Name:HERMITAGE THERAPY GROUP
Entity Type:Organization
Organization Name:HERMITAGE THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CCC-SLP
Authorized Official - Phone:803-414-0441
Mailing Address - Street 1:5041 TIMBER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6344
Mailing Address - Country:US
Mailing Address - Phone:803-414-0441
Mailing Address - Fax:
Practice Address - Street 1:5041 TIMBER TRAIL DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6344
Practice Address - Country:US
Practice Address - Phone:803-414-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty