Healthcare Provider Details

I. General information

NPI: 1891026803
Provider Name (Legal Business Name): INNOVATIVE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BROAD CREEK RD
NEW BERN NC
28560-7102
US

IV. Provider business mailing address

1030 BROAD CREEK RD
NEW BERN NC
28560-7102
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-6335
  • Fax: 252-635-1130
Mailing address:
  • Phone: 252-633-6335
  • Fax: 252-635-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TRACY P INGRAM
Title or Position: OPERATOR
Credential:
Phone: 252-633-6335