Provider Demographics
NPI:1114017464
Name:INTEGRATIVE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL THERAPY, PLLC
Other - Org Name:INTEGRATIVE PHYSICAL THERAPY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:P.T. , QWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-281-3534
Mailing Address - Street 1:1 BARNEY ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0471
Mailing Address - Country:US
Mailing Address - Phone:518-373-0735
Mailing Address - Fax:518-373-7967
Practice Address - Street 1:1 BARNEY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-5843
Practice Address - Country:US
Practice Address - Phone:518-373-0735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01-4487-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1654Medicare ID - Type Unspecified