Provider Demographics
NPI:1740748045
Name:INTEGRATE2 PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INTEGRATE2 PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:678-909-9278
Mailing Address - Street 1:110 EVANS MILL DR STE 206
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-1624
Mailing Address - Country:US
Mailing Address - Phone:678-909-9278
Mailing Address - Fax:833-264-6634
Practice Address - Street 1:110 EVANS MILL DR STE 206
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1624
Practice Address - Country:US
Practice Address - Phone:678-909-9278
Practice Address - Fax:833-264-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Single Specialty