Provider Demographics
NPI:1811376510
Name:INTEGRATED PHYSICAL THERAPY
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-655-9380
Mailing Address - Street 1:812 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1246
Mailing Address - Country:US
Mailing Address - Phone:630-655-9380
Mailing Address - Fax:630-655-9386
Practice Address - Street 1:812 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1246
Practice Address - Country:US
Practice Address - Phone:630-655-9380
Practice Address - Fax:630-655-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty