Provider Demographics
NPI:1669090411
Name:THERAPEUTIC INNOVATIONS, LLC
Entity type:Organization
Organization Name:THERAPEUTIC INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-294-4491
Mailing Address - Street 1:1957 THOMPSON RD STE H
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2040
Mailing Address - Country:US
Mailing Address - Phone:541-294-4491
Mailing Address - Fax:541-808-0790
Practice Address - Street 1:1957 THOMPSON RD STE H
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2040
Practice Address - Country:US
Practice Address - Phone:541-294-4491
Practice Address - Fax:541-808-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1689137812Medicaid
OR1073897112Medicaid