Provider Demographics
NPI:1437363363
Name:INTEGRATIVE THERAPY SERVICES INCORPORATED
Entity Type:Organization
Organization Name:INTEGRATIVE THERAPY SERVICES INCORPORATED
Other - Org Name:KOALA KIDS PEDIATRIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BIENKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC-SLP
Authorized Official - Phone:727-526-5432
Mailing Address - Street 1:3901 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5603
Mailing Address - Country:US
Mailing Address - Phone:727-526-5432
Mailing Address - Fax:727-526-5432
Practice Address - Street 1:3901 16TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-5603
Practice Address - Country:US
Practice Address - Phone:727-526-5432
Practice Address - Fax:727-526-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889947900Medicaid