Provider Demographics
NPI:1609226059
Name:INTEGRATIVE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:INTEGRATIVE PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-523-9664
Mailing Address - Street 1:1928 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-3445
Mailing Address - Country:US
Mailing Address - Phone:541-523-9664
Mailing Address - Fax:541-523-9665
Practice Address - Street 1:1928 COURT AVE
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-3445
Practice Address - Country:US
Practice Address - Phone:541-523-9664
Practice Address - Fax:541-523-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OR03918261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1265459093OtherINDIVIDUAL NPI