Healthcare Provider Details

I. General information

NPI: 1952265498
Provider Name (Legal Business Name): INNOVATIVE MOBILE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 E COUNTY ROAD 36
TIFFIN OH
44883-9727
US

IV. Provider business mailing address

4423 E COUNTY ROAD 36
TIFFIN OH
44883-9727
US

V. Phone/Fax

Practice location:
  • Phone: 419-210-5311
  • Fax:
Mailing address:
  • Phone: 419-210-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LUCAS TRENT LEPPLA
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 419-210-5311