Provider Demographics
NPI:1346657673
Name:INTEGRATED THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INTEGRATED THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BLOOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-648-0099
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-0545
Mailing Address - Country:US
Mailing Address - Phone:616-884-5827
Mailing Address - Fax:616-884-5828
Practice Address - Street 1:251 NORTHLAND DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1041
Practice Address - Country:US
Practice Address - Phone:616-884-5827
Practice Address - Fax:616-884-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008415261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N95540012Medicare UPIN