Provider Demographics
NPI:1205067857
Name:THERAPEUTIC INNOVATIONS LC
Entity type:Organization
Organization Name:THERAPEUTIC INNOVATIONS LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:D'AQUILA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:314-471-1881
Mailing Address - Street 1:563 CLIFF CAVE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4415
Mailing Address - Country:US
Mailing Address - Phone:314-293-2463
Mailing Address - Fax:
Practice Address - Street 1:563 CLIFF CAVE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4415
Practice Address - Country:US
Practice Address - Phone:314-293-2463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004033190261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy