Provider Demographics
NPI:1275633588
Name:THERAPY INNOVATIONS, INC
Entity Type:Organization
Organization Name:THERAPY INNOVATIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLACKSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-843-2339
Mailing Address - Street 1:108 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2736
Mailing Address - Country:US
Mailing Address - Phone:662-843-2339
Mailing Address - Fax:662-846-1397
Practice Address - Street 1:108 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2736
Practice Address - Country:US
Practice Address - Phone:662-843-2339
Practice Address - Fax:662-846-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03202536Medicaid
MS04031891Medicaid