Provider Demographics
NPI:1003980343
Name:INTEGRATIVE MANUAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:INTEGRATIVE MANUAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TANSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-781-8358
Mailing Address - Street 1:PO BOX 6099
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105
Mailing Address - Country:US
Mailing Address - Phone:207-781-8358
Mailing Address - Fax:207-781-8357
Practice Address - Street 1:74 LUNT ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105
Practice Address - Country:US
Practice Address - Phone:207-781-8358
Practice Address - Fax:207-781-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM7745Medicare ID - Type Unspecified