Provider Demographics
NPI:1477891471
Name:INTEGRATED BODY THERAPIES, INC.
Entity Type:Organization
Organization Name:INTEGRATED BODY THERAPIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:612-867-2734
Mailing Address - Street 1:1901 FREDEEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2412
Mailing Address - Country:US
Mailing Address - Phone:651-653-0786
Mailing Address - Fax:651-762-7944
Practice Address - Street 1:1901 FREDEEN RD
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-2412
Practice Address - Country:US
Practice Address - Phone:651-653-0786
Practice Address - Fax:651-762-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA8782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN103503OtherABMP
MN7068-00OtherNCTMB