Provider Demographics
NPI:1013670512
Name:INTEGRATIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL THERAPY LLC
Other - Org Name:INTEGRATIVE PHYSICAL THERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-514-9555
Mailing Address - Street 1:8 BEAVERBROOK HL
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9433
Mailing Address - Country:US
Mailing Address - Phone:541-514-0955
Mailing Address - Fax:
Practice Address - Street 1:305 SAINT PAUL ST STE 321
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5073
Practice Address - Country:US
Practice Address - Phone:802-557-1349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy