Provider Demographics
NPI:1962650788
Name:INTEGRATED PEDIATRIC THERAPIES, P.C.
Entity Type:Organization
Organization Name:INTEGRATED PEDIATRIC THERAPIES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, DPT, PCS
Authorized Official - Phone:303-870-9302
Mailing Address - Street 1:1027 TURNBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9594
Mailing Address - Country:US
Mailing Address - Phone:303-870-9302
Mailing Address - Fax:303-433-1574
Practice Address - Street 1:1027 TURNBERRY CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9594
Practice Address - Country:US
Practice Address - Phone:303-870-9302
Practice Address - Fax:303-433-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8372252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07802773Medicaid