Provider Demographics
NPI:1801007257
Name:INTEGRATIVE THERAPY, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CITERONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-842-8463
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-6366
Mailing Address - Country:US
Mailing Address - Phone:304-842-8463
Mailing Address - Fax:
Practice Address - Street 1:200 HELIPORT LOOP ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-6366
Practice Address - Country:US
Practice Address - Phone:304-842-8463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV70919251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health