Provider Demographics
NPI:1174768360
Name:INNOVATIVE THERAPIES GROUP INC
Entity type:Organization
Organization Name:INNOVATIVE THERAPIES GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:352-216-1911
Mailing Address - Street 1:929 HWY 27/441
Mailing Address - Street 2:UNIT 301
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3002
Mailing Address - Country:US
Mailing Address - Phone:352-433-0091
Mailing Address - Fax:352-433-0676
Practice Address - Street 1:929 HWY 27/441
Practice Address - Street 2:UNIT 301
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3002
Practice Address - Country:US
Practice Address - Phone:352-433-0091
Practice Address - Fax:352-433-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 00330225100000X
FLOT 4267225XH1200X, 225X00000X
FLSA 2999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBM730Medicare PIN