Provider Demographics
NPI:1770367351
Name:FUNDAMENTALS LLC
Entity type:Organization
Organization Name:FUNDAMENTALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KEYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-910-6776
Mailing Address - Street 1:326 CHAMBERLIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 GOTHIC CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2811
Practice Address - Country:US
Practice Address - Phone:615-910-6776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech