Full Spectrum Pediatric Therapy, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 6520 Issued in TN

Legal business name

FULL SPECTRUM PEDIATRIC THERAPY, INC.

Practice address

298 Warfield Blvd, Suite C
Clarksville, TN 37043-1896

Phone

(931) 906-0440

Fax

(931) 920-5070

NPI assigned

Feb 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lana Kareen Broome, OTR/LNPI 1487706701

Title

Owner/President

Phone

(931) 906-0440

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Full Spectrum Rehab Center Former legal business name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255472403. Details of each certification follow.

• CCN 446659 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 446659

Legal name

FULL SPECTRUM PEDIATRIC THERAPY, INC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Sep 27, 2001

Last certification

May 29, 2025

Ownership / control type

Proprietary

Facility address

298 Warfield Blvd Ste C
Clarksville, TN 37043

Tax ID family

Full Spectrum Pediatric Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Full Spectrum Pediatric Therapy

  • Occupational Therapy Assistant
  • Clarksville, TN
  • NPI 1679987606
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lana Kareen Broome, OTR

  • Occupational Therapist
  • Clarksville, TN
  • NPI 1487706701
  NPD Authorized official
• Jodi Jean Ball, OTR L

  • Occupational Therapist
  • Clarksville, TN
  • NPI 1861599557
  NPD (past)
• Magan Renee Brissel, COTA

  • Occupational Therapy Assistant
  • Clarksville, TN
  • NPI 1710169347
  NPD (past)
• Mary Catherine Lang, PT

  • Physical Therapist
  • Clarksville, TN
  • NPI 1033215579
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1255472403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "298 WARFIELD BLVD, SUITE C",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370431896",
            "telephone_number": "931-906-0440",
            "fax_number": "931-920-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 WARFIELD BLVD, SUITE C",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370431896",
            "telephone_number": "931-906-0440",
            "fax_number": "931-920-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL SPECTRUM PEDIATRIC THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "BROOME",
        "authorized_official_first_name": "LANA",
        "authorized_official_middle_name": "KAREEN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "931-906-0440",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "PT 6520",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "OT 2156",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE PROVIDER NUMBER",
            "identifier": "4004828",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "4004828",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Full Spectrum Rehab Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• FRPG, LLC
• Amanda Jean Fryer, FNP-C
• Erien Wynne Fryer
• Gregory Marcel Fryer, M.D.
• Full Spectrum Pediatric Therapy
• Fuller Rehabilitation and Consulting Services Inc. (Independent Living Aids)
• Danielle Fuller, R.N.
• Jessica Fuller, RBT
• Kiah Fuller
• Nicole Shante Fulton

• Physical Therapist in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.