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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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