Provider Demographics
NPI:1518950815
Name:THERAPEUTIC INTERVENTION PROGRAMS, INC.
Entity Type:Organization
Organization Name:THERAPEUTIC INTERVENTION PROGRAMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:952-936-9215
Mailing Address - Street 1:10721 SMETANA RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8080
Mailing Address - Country:US
Mailing Address - Phone:952-936-9215
Mailing Address - Fax:952-936-9942
Practice Address - Street 1:10721 SMETANA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-8080
Practice Address - Country:US
Practice Address - Phone:952-936-9215
Practice Address - Fax:952-936-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
MN03158251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Not Answered251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN164018OtherMN U CARE
MN25G91THOtherBLUE CROSS/BLUE SHIELD
MN1013116OtherPREFERRED ONE
MN64308OtherMEDICA HEALTH PLANS
MN60846086OtherUNITED HEALTHCARE
MN899OtherHEALTHPARTNERS, INC.
MN11880MOOtherBLUECROSS/BLUE SHIELD
MN34155928OtherPATIENT CHOICE
MN7G855THOtherBLUE CROSS/BLUE SHIELD