Provider Demographics
NPI:1275764920
Name:INTEGRATIVE PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:INTEGRATIVE PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CDT-D, SIPT CERT
Authorized Official - Phone:972-404-3077
Mailing Address - Street 1:6101 WINDCOM COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-608-0909
Mailing Address - Fax:469-429-2065
Practice Address - Street 1:12840 HILLCREST ROAD
Practice Address - Street 2:SUITE E-104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-404-3077
Practice Address - Fax:972-404-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066306261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center