Provider Demographics
NPI:1790585610
Name:2083 THERAPY, LLC
Entity type:Organization
Organization Name:2083 THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-469-4151
Mailing Address - Street 1:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-0558
Mailing Address - Country:US
Mailing Address - Phone:601-469-4151
Mailing Address - Fax:601-469-9927
Practice Address - Street 1:113 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-6504
Practice Address - Country:US
Practice Address - Phone:601-469-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:2083 THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy