Provider Demographics
NPI:1548206691
Name:INTEGRATED PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNTTONEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-385-0644
Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-385-0644
Mailing Address - Fax:970-385-0620
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-385-0644
Practice Address - Fax:970-385-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64872831Medicaid
COC377008Medicare PIN