Provider Demographics
NPI:1417735473
Name:THORACIC PARK HOLDINGS LLC
Entity Type:Organization
Organization Name:THORACIC PARK HOLDINGS LLC
Other - Org Name:INTEGRAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:617-275-6818
Mailing Address - Street 1:11169 E I25 FRONTAGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5211
Mailing Address - Country:US
Mailing Address - Phone:720-600-0370
Mailing Address - Fax:
Practice Address - Street 1:5641 IRIS PKWY UNIT D
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80504-6925
Practice Address - Country:US
Practice Address - Phone:720-600-0370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty