Provider Demographics
NPI:1205547874
Name:EMPOWERED FOUNDATIONS THERAPY LLC
Entity type:Organization
Organization Name:EMPOWERED FOUNDATIONS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, LMT
Authorized Official - Phone:804-502-1890
Mailing Address - Street 1:114 CREEKSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-6644
Mailing Address - Country:US
Mailing Address - Phone:804-502-1890
Mailing Address - Fax:
Practice Address - Street 1:815 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4507
Practice Address - Country:US
Practice Address - Phone:804-502-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation