Provider Demographics
NPI:1356470728
Name:INTERACTIVE THERAPIES & FITNESS, INC.
Entity type:Organization
Organization Name:INTERACTIVE THERAPIES & FITNESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:336-209-6927
Mailing Address - Street 1:3329 OWLS ROOST RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9746
Mailing Address - Country:US
Mailing Address - Phone:336-209-6927
Mailing Address - Fax:336-294-4216
Practice Address - Street 1:3329 OWLS ROOST RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9746
Practice Address - Country:US
Practice Address - Phone:336-209-6927
Practice Address - Fax:336-294-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412404Medicaid
NC7211502Medicaid
NC7411719Medicaid
NC7412106Medicaid
NC1447384128Medicare UPIN
NC7411719Medicaid