Provider Demographics
NPI:1669251369
Name:PURE THERAPY, LLC
Entity type:Organization
Organization Name:PURE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HALF OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAELA
Authorized Official - Middle Name:TEMPLE
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:601-870-4360
Mailing Address - Street 1:7955 HUCKLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-7086
Mailing Address - Country:US
Mailing Address - Phone:601-870-4360
Mailing Address - Fax:
Practice Address - Street 1:7955 HUCKLEBERRY LN
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-7086
Practice Address - Country:US
Practice Address - Phone:601-870-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty