Provider Demographics
NPI:1639161797
Name:INNOVATIONS IN PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:INNOVATIONS IN PHYSICAL THERAPY, INC.
Other - Org Name:MED CENTER THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-668-1818
Mailing Address - Street 1:2229 DORRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3208
Mailing Address - Country:US
Mailing Address - Phone:713-668-1818
Mailing Address - Fax:713-838-2238
Practice Address - Street 1:2229 DORRINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3208
Practice Address - Country:US
Practice Address - Phone:713-668-1818
Practice Address - Fax:713-838-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD0248OtherRR MEDICARE GRP PRVDR #
TX0047LKOtherBCBS GROUP PROVIDER #
DD0248OtherRR MEDICARE GRP PRVDR #