Provider Demographics
NPI:1669488334
Name:INTEGRATED MEDICAL THERAPY GROUP LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL THERAPY GROUP LLC
Other - Org Name:TREASURE COAST PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:CPEDC
Authorized Official - Phone:772-567-1552
Mailing Address - Street 1:3745 11TH CIR STE 108
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4838
Mailing Address - Country:US
Mailing Address - Phone:772-567-1552
Mailing Address - Fax:772-567-5269
Practice Address - Street 1:3745 11TH CIR STE 108
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4838
Practice Address - Country:US
Practice Address - Phone:772-567-1552
Practice Address - Fax:772-567-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNPK0NOtherBCBS