Provider Demographics
NPI:1922034552
Name:INTEGRAS THERAPY & WELLNESS CENTERS INC
Entity Type:Organization
Organization Name:INTEGRAS THERAPY & WELLNESS CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAUNCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-674-7639
Mailing Address - Street 1:17352 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-1763
Mailing Address - Country:US
Mailing Address - Phone:850-674-7639
Mailing Address - Fax:850-674-4305
Practice Address - Street 1:17352 MAIN ST N
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1763
Practice Address - Country:US
Practice Address - Phone:850-674-4300
Practice Address - Fax:850-674-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890142200Medicaid
FL890142200Medicaid