Provider Demographics
NPI:1558619049
Name:INTEGRATION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:INTEGRATION PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, PRC
Authorized Official - Phone:712-490-3494
Mailing Address - Street 1:3450 S LAKEPORT ST STE B
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4543
Mailing Address - Country:US
Mailing Address - Phone:712-276-2906
Mailing Address - Fax:712-276-3090
Practice Address - Street 1:3450 S LAKEPORT ST STE B
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4543
Practice Address - Country:US
Practice Address - Phone:712-276-2906
Practice Address - Fax:712-276-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty