Provider Demographics
NPI:1346284460
Name:INTEGRATED PHYSICAL THERAPY,INC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE-LEWIS
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:218-722-3800
Mailing Address - Street 1:324 W. SUPERIOR ST
Mailing Address - Street 2:SUITE 428
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-722-3800
Mailing Address - Fax:218-722-3800
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:SUITE 428
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-722-3800
Practice Address - Fax:218-722-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4018261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy