Provider Demographics
NPI:1679109623
Name:INTEGRATIVE THERAPY SPECIALIST
Entity Type:Organization
Organization Name:INTEGRATIVE THERAPY SPECIALIST
Other - Org Name:INTEGRATIVE PHYSICAL THERAPY SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:903-276-4247
Mailing Address - Street 1:813 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6628
Mailing Address - Country:US
Mailing Address - Phone:903-276-4247
Mailing Address - Fax:
Practice Address - Street 1:813 TIMBER DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6628
Practice Address - Country:US
Practice Address - Phone:903-276-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation