Provider Demographics
NPI:1871925768
Name:TRI CITY THERAPY, LLC
Entity type:Organization
Organization Name:TRI CITY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-258-5045
Mailing Address - Street 1:15575 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-3801
Mailing Address - Country:US
Mailing Address - Phone:276-258-5045
Mailing Address - Fax:276-258-5046
Practice Address - Street 1:15575 LEE HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-3801
Practice Address - Country:US
Practice Address - Phone:276-258-5045
Practice Address - Fax:276-258-5046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency