Provider Demographics
NPI:1891151627
Name:INTEGRAL PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:INTEGRAL PHYSICAL THERAPY PLLC
Other - Org Name:INTEGRAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:720-600-0370
Mailing Address - Street 1:11169 E I25 FRONTAGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5211
Mailing Address - Country:US
Mailing Address - Phone:720-600-0370
Mailing Address - Fax:720-600-0374
Practice Address - Street 1:11169 E I25 FRONTAGE RD STE C
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-5211
Practice Address - Country:US
Practice Address - Phone:720-600-0370
Practice Address - Fax:720-600-0374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRAL PHYSICAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-08
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9785261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy