Organization
THERAPY INNOVATIONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACY MARIE BLACKSTOCK PT (VICE PRESIDENT)
(662) 843-2339
Entity
Organization
Contact information
Practice address
108 COMMERCE AVE, CLEVELAND, MS 38732-2736
(662) 843-2339
(662) 846-1397
Mailing address
108 COMMERCE AVE, CLEVELAND, MS 38732-2736
(662) 843-2339
(662) 846-1397
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03202536
—
MS
05
—
04031891
—
MS
Enumeration date
09/25/2006
Last updated
10/13/2009
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