Provider Demographics
NPI:1861860405
Name:INDEPENDENT THERAPY NETWORK
Entity Type:Organization
Organization Name:INDEPENDENT THERAPY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOSICK JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-A/SLP
Authorized Official - Phone:901-340-7276
Mailing Address - Street 1:3490 FOREST HILL IRENE RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-8500
Mailing Address - Country:US
Mailing Address - Phone:901-624-9931
Mailing Address - Fax:
Practice Address - Street 1:3490 FOREST HILL IRENE RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-8500
Practice Address - Country:US
Practice Address - Phone:901-624-9931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPSS0000000193251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services