Provider Demographics
NPI:1376961300
Name:INTEGRAL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:INTEGRAL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:610-743-4633
Mailing Address - Street 1:506 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2920
Mailing Address - Country:US
Mailing Address - Phone:610-743-4633
Mailing Address - Fax:610-743-4632
Practice Address - Street 1:506 N PARK RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2920
Practice Address - Country:US
Practice Address - Phone:610-743-4633
Practice Address - Fax:610-743-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT01171E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty