1356391452 NPI number — THERAPEUTIC TECHNIQUES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356391452 NPI number — THERAPEUTIC TECHNIQUES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC TECHNIQUES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356391452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1836
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALUMET CITY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60409-7836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-474-6590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16820 MANOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HOLLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60473-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-474-6590
Provider Business Practice Location Address Fax Number:
708-474-6599
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROUNDTREE
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
YUDORA
Authorized Official Title or Position:
PRESIDENT/DIRECTOR
Authorized Official Telephone Number:
708-414-6590

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  056002350 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0163598 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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