Provider Demographics
NPI:1811032774
Name:INTEGRATED PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-241-1144
Mailing Address - Street 1:609 FARMINGTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3081
Mailing Address - Country:US
Mailing Address - Phone:860-241-1144
Mailing Address - Fax:860-241-1188
Practice Address - Street 1:609 FARMINGTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3081
Practice Address - Country:US
Practice Address - Phone:860-241-1144
Practice Address - Fax:860-241-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
650000872Medicare ID - Type Unspecified