Provider Demographics
NPI:1588016745
Name:THERAPY SQUAD LLC
Entity type:Organization
Organization Name:THERAPY SQUAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:205-820-0303
Mailing Address - Street 1:399 LAREDO DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-419-2966
Practice Address - Street 1:399 LAREDO DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2367
Practice Address - Country:US
Practice Address - Phone:205-820-0303
Practice Address - Fax:205-419-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3814261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech