Provider Demographics
NPI:1063688042
Name:INTEGRATED SPORTS THERAPY, PC
Entity Type:Organization
Organization Name:INTEGRATED SPORTS THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZEBRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-292-9353
Mailing Address - Street 1:180 POST ROAD EAST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3414
Mailing Address - Country:US
Mailing Address - Phone:203-292-9353
Mailing Address - Fax:203-292-9532
Practice Address - Street 1:180 POST RD E STE 209
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3414
Practice Address - Country:US
Practice Address - Phone:203-292-9353
Practice Address - Fax:203-292-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001725111N00000X
CT007391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty