Provider Demographics
NPI:1053312470
Name:INNOVATIVE THERAPY, LLC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-737-7000
Mailing Address - Street 1:3 HOMESTEAD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357-3728
Mailing Address - Country:US
Mailing Address - Phone:207-737-7000
Mailing Address - Fax:207-737-7028
Practice Address - Street 1:3 HOMESTEAD WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357-3728
Practice Address - Country:US
Practice Address - Phone:207-737-7000
Practice Address - Fax:207-737-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAA26682OtherHARVARD PILGRIM
ME061229OtherANTHEM
ME7872333OtherAETNA
MEC03561645OtherMARTINS POINT
ME604283700OtherUS DEPT. OF LABOR
ME061229OtherANTHEM