Provider Demographics
NPI:1962688838
Name:INTEGRATED THERAPY PRACTICE, INC.
Entity Type:Organization
Organization Name:INTEGRATED THERAPY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED,PT
Authorized Official - Phone:435-755-3113
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84323-0411
Mailing Address - Country:US
Mailing Address - Phone:435-755-3113
Mailing Address - Fax:435-755-3123
Practice Address - Street 1:189 N 200 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4605
Practice Address - Country:US
Practice Address - Phone:435-755-3113
Practice Address - Fax:435-755-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120344-2401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty