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Organization
THERAPEUTIC INNOVATIONS INC
Active
Organization
THERAPEUTIC INNOVATIONS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LENARD MILLER (VICE PRESIDENT)
(765) 563-6868
Entity
Organization
Contact information
Practice address
111 W THIRD ST, BROOKSTON, IN 47623-0404
(765) 563-6868
Mailing address
111 W THIRD ST, PO BOX 404, BROOKSTON, IN 47623-0404
(765) 563-6868
(765) 563-3990
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05000581A
IN
225X00000X
Occupational Therapist
31000116A
IN
332B00000X
Durable Medical Equipment & Medical Supplies
69000280A
IN
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000281243
ANTHEM BLUE CROSS BLUE SHIELD
IN
01
—
000000508874
ANTHEM BLUE CROSS BLUE SHIELD
IN
01
—
000000511018
ANTHEM BLUE CROSS BLUE SHIELD
IN
05
—
100262780A
—
IN
05
—
200326830
—
IN
01
—
200715320
EI GROUP NUMBER
IN
Enumeration date
05/25/2006
Last updated
06/06/2008
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