Provider Demographics
NPI:1487400867
Name:INNOVATIVE TRIANGLE THERAPIES, PLLC
Entity type:Organization
Organization Name:INNOVATIVE TRIANGLE THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:919-629-0202
Mailing Address - Street 1:2918 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4705
Mailing Address - Country:US
Mailing Address - Phone:919-629-0202
Mailing Address - Fax:919-910-5537
Practice Address - Street 1:2918 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4705
Practice Address - Country:US
Practice Address - Phone:919-629-0202
Practice Address - Fax:919-910-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty