Provider Demographics
NPI:1356391452
Name:THERAPEUTIC TECHNIQUES, INC.
Entity type:Organization
Organization Name:THERAPEUTIC TECHNIQUES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:YUDORA
Authorized Official - Last Name:ROUNDTREE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:708-414-6590
Mailing Address - Street 1:PO BOX 1836
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-7836
Mailing Address - Country:US
Mailing Address - Phone:708-474-6590
Mailing Address - Fax:
Practice Address - Street 1:16820 MANOR DR
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-4608
Practice Address - Country:US
Practice Address - Phone:708-474-6590
Practice Address - Fax:708-474-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002350251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0163598OtherBLUE CROSS BLUE SHIELD