Provider Demographics
NPI:1083035653
Name:INTEGRATIVE REHABILITATION PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE REHABILITATION PLLC
Other - Org Name:PHILADELPHIA INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:TETLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-702-7974
Mailing Address - Street 1:200 EAGLE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3115
Mailing Address - Country:US
Mailing Address - Phone:888-702-7974
Mailing Address - Fax:888-702-7974
Practice Address - Street 1:200 EAGLE RD STE 208
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3115
Practice Address - Country:US
Practice Address - Phone:888-702-7974
Practice Address - Fax:888-702-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty