Healthcare Provider Details

I. General information

NPI: 1437174158
Provider Name (Legal Business Name): INNOVATIVE THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13910 JOG RD STE 102
DELRAY BEACH FL
33446-5908
US

IV. Provider business mailing address

1602 N LAKESIDE DR
LAKE WORTH FL
33460-6610
US

V. Phone/Fax

Practice location:
  • Phone: 561-824-0234
  • Fax: 561-824-0235
Mailing address:
  • Phone: 561-824-0234
  • Fax: 561-824-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. GWENDOLYN JEAN BOYD
Title or Position: VICEPRESIDENT
Credential: PT
Phone: 561-824-0234