Provider Demographics
NPI:1619199775
Name:INTEGRATED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KUENNING
Authorized Official - Suffix:
Authorized Official - Credentials:MP T
Authorized Official - Phone:619-542-1594
Mailing Address - Street 1:1775 HANCOCK ST
Mailing Address - Street 2:130
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2034
Mailing Address - Country:US
Mailing Address - Phone:619-542-1594
Mailing Address - Fax:619-542-1595
Practice Address - Street 1:1775 HANCOCK ST
Practice Address - Street 2:130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2034
Practice Address - Country:US
Practice Address - Phone:619-542-1594
Practice Address - Fax:619-542-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21309261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19176Medicare ID - Type UnspecifiedMEDICARE