Provider Demographics
NPI:1467505594
Name:INNOVATIVE THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY SERVICES INC.
Other - Org Name:THE THERAPY PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:IADAROLA
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:502-893-0050
Mailing Address - Street 1:173 SEARS AVE
Mailing Address - Street 2:#181
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5059
Mailing Address - Country:US
Mailing Address - Phone:502-893-0050
Mailing Address - Fax:502-893-0049
Practice Address - Street 1:173 SEARS AVE
Practice Address - Street 2:#181
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5059
Practice Address - Country:US
Practice Address - Phone:502-893-0050
Practice Address - Fax:502-893-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY025507892225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3300098500Medicaid
KY3300098500Medicaid