Provider Demographics
NPI:1689622300
Name:ADDITIONS THERAPY, LLC
Entity Type:Organization
Organization Name:ADDITIONS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:865-643-0598
Mailing Address - Street 1:1125 GROVE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1512
Mailing Address - Country:US
Mailing Address - Phone:865-458-8080
Mailing Address - Fax:
Practice Address - Street 1:1125 GROVE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1512
Practice Address - Country:US
Practice Address - Phone:865-458-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446686Medicaid
4131139OtherBCBS
TN446686Medicare Oscar/Certification