Provider Demographics
NPI:1568544757
Name:INTEGRATIVE PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEBOO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-715-8686
Mailing Address - Street 1:2114 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4140
Mailing Address - Country:US
Mailing Address - Phone:360-715-8686
Mailing Address - Fax:360-715-1680
Practice Address - Street 1:2114 JAMES ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4140
Practice Address - Country:US
Practice Address - Phone:360-715-8686
Practice Address - Fax:360-715-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602346794225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122088Medicaid
WA0180793OtherLABOR AND INDUSTRIES
WA0180793OtherLABOR AND INDUSTRIES