Provider Demographics
NPI:1205957016
Name:INNOVATION REHABILITATION
Entity type:Organization
Organization Name:INNOVATION REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-492-2504
Mailing Address - Street 1:451 RUIN CREEK RD
Mailing Address - Street 2:INNOVATION REHABILITATION, SUITE 104
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2878
Mailing Address - Country:US
Mailing Address - Phone:252-492-2504
Mailing Address - Fax:
Practice Address - Street 1:2309 SPARGER RD
Practice Address - Street 2:INNOVATION REHABILITATION
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2227
Practice Address - Country:US
Practice Address - Phone:252-492-2504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty