Provider Demographics
NPI:1982208781
Name:INNOVATIVE THERAPY LLC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY LLC
Other - Org Name:INNOVATIVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:757-450-0977
Mailing Address - Street 1:900 COMMONWEALTH PLACE, SUITE 365
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-373-2023
Mailing Address - Fax:757-447-0139
Practice Address - Street 1:900 COMMONWEALTH PLACE, SUITE 365
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464
Practice Address - Country:US
Practice Address - Phone:757-373-2023
Practice Address - Fax:757-447-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty