Provider Demographics
NPI:1336907260
Name:INNOVATIVE THERAPY P.C.
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-225-8530
Mailing Address - Street 1:13747 MONTFORT DR STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4497
Mailing Address - Country:US
Mailing Address - Phone:214-225-8530
Mailing Address - Fax:
Practice Address - Street 1:13747 MONTFORT DR STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4497
Practice Address - Country:US
Practice Address - Phone:214-225-8530
Practice Address - Fax:888-816-3627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE THERAPY P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies