Provider Demographics
NPI:1114229036
Name:SPECIALIZED INNOVATIVE THERAPIES, LLC
Entity Type:Organization
Organization Name:SPECIALIZED INNOVATIVE THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RASBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-319-3149
Mailing Address - Street 1:14124 ASTON FALLS DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-2408
Mailing Address - Country:US
Mailing Address - Phone:817-454-9930
Mailing Address - Fax:817-439-5274
Practice Address - Street 1:14124 ASTON FALLS DR
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-2408
Practice Address - Country:US
Practice Address - Phone:817-454-9930
Practice Address - Fax:817-439-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL09005225A00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty