Basic Information
| Provider Information | |||||||||
| NPI: | 1184662066 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE THERAPIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7536 HAVERFORD AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191512109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158774600 | ||||||||
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| Address1: | 7536 HAVERFORD AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191512109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158774600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AHRAM | ||||||||
| AuthorizedOfficialFirstName: | JUDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2158774600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT000986 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.