Provider Demographics
NPI:1891026803
Name:INNOVATIVE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY SERVICES LLC
Other - Org Name:INNOVATIVE THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:P
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-6335
Mailing Address - Street 1:1030 BROAD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-7102
Mailing Address - Country:US
Mailing Address - Phone:252-633-6335
Mailing Address - Fax:252-635-1130
Practice Address - Street 1:1030 BROAD CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-7102
Practice Address - Country:US
Practice Address - Phone:252-633-6335
Practice Address - Fax:252-635-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty