Provider Demographics
NPI:1477166270
Name:INTEGRATIVE PHYSICAL HEALTH LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CIOLKOSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-220-0064
Mailing Address - Street 1:3105 LIMESTONE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2156
Mailing Address - Country:US
Mailing Address - Phone:302-220-0064
Mailing Address - Fax:
Practice Address - Street 1:3105 LIMESTONE RD STE 303
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2156
Practice Address - Country:US
Practice Address - Phone:302-220-0064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty