Provider Demographics
NPI:1063623924
Name:ADVANCED THERAPY INNOVATIONS LLC
Entity type:Organization
Organization Name:ADVANCED THERAPY INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VENDITTI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:812-204-8871
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-0494
Mailing Address - Country:US
Mailing Address - Phone:812-897-3393
Mailing Address - Fax:812-897-3396
Practice Address - Street 1:5236 VOGEL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7814
Practice Address - Country:US
Practice Address - Phone:812-204-8871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
IN05006974A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherEIN