Healthcare Provider Details

I. General information

NPI: 1295662187
Provider Name (Legal Business Name): FIRST FOUNDATIONS PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12492 KENTUCK RD
SUTHERLIN VA
24594-3900
US

IV. Provider business mailing address

12492 KENTUCK RD
SUTHERLIN VA
24594-3900
US

V. Phone/Fax

Practice location:
  • Phone: 276-733-5692
  • Fax: 276-208-0010
Mailing address:
  • Phone: 276-733-5692
  • Fax: 276-208-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JULIA BURNETT
Title or Position: OWNER/SLP
Credential: MS, CCC-SLP
Phone: 276-733-5692