Provider Demographics
NPI:1891232393
Name:INTEGRATED PHYSICAL THERAPY & SPORTS REHABILITATION PLLC
Entity Type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY & SPORTS REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-729-7050
Mailing Address - Street 1:1057 SALMA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1586
Mailing Address - Country:US
Mailing Address - Phone:248-909-9880
Mailing Address - Fax:
Practice Address - Street 1:901 TOWER DR STE 190
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2805
Practice Address - Country:US
Practice Address - Phone:248-729-7050
Practice Address - Fax:248-729-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty