Provider Demographics
NPI:1023064805
Name:THERAPEUTIC INNOVATIONS INC
Entity type:Organization
Organization Name:THERAPEUTIC INNOVATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LENARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-563-6868
Mailing Address - Street 1:111 W THIRD ST
Mailing Address - Street 2:PO BOX 404
Mailing Address - City:BROOKSTON
Mailing Address - State:IN
Mailing Address - Zip Code:47623-0404
Mailing Address - Country:US
Mailing Address - Phone:765-563-6868
Mailing Address - Fax:765-563-3990
Practice Address - Street 1:111 W THIRD ST
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:IN
Practice Address - Zip Code:47623-0404
Practice Address - Country:US
Practice Address - Phone:765-563-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000116A225X00000X
IN69000280A332B00000X
332BC3200X
IN05000581A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100262780AMedicaid
IN200326830Medicaid
IN000000508874OtherANTHEM BLUE CROSS BLUE SHIELD
IN200715320OtherEI GROUP NUMBER
IN000000281243OtherANTHEM BLUE CROSS BLUE SHIELD
IN000000511018OtherANTHEM BLUE CROSS BLUE SHIELD