Provider Demographics
NPI:1639856073
Name:ROOTED THERAPY SERVICES LLC
Entity type:Organization
Organization Name:ROOTED THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:440-479-7454
Mailing Address - Street 1:1070 E CEDAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:HARTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65039-9495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 E CEDAR TREE LN
Practice Address - Street 2:
Practice Address - City:HARTSBURG
Practice Address - State:MO
Practice Address - Zip Code:65039-9495
Practice Address - Country:US
Practice Address - Phone:440-479-7454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016039132OtherPROFESSIONAL REGISTRATION