Healthcare Provider Details

I. General information

NPI: 1407793128
Provider Name (Legal Business Name): FUNDAMENTAL THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 KAYAK AVE
CAPITOL HEIGHTS MD
20743-4045
US

IV. Provider business mailing address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

V. Phone/Fax

Practice location:
  • Phone: 917-864-7997
  • Fax:
Mailing address:
  • Phone: 917-864-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSHA MARIE LAWRENCE
Title or Position: SLP/ MANAGER
Credential: CCC-SLP
Phone: 917-864-7997