Provider Demographics
NPI:1205140654
Name:INTEGRATED PHYSIOTHERAPY, INC.
Entity type:Organization
Organization Name:INTEGRATED PHYSIOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MASSIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:719-635-7844
Mailing Address - Street 1:21 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-1819
Mailing Address - Country:US
Mailing Address - Phone:719-685-4779
Mailing Address - Fax:
Practice Address - Street 1:4460 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3813
Practice Address - Country:US
Practice Address - Phone:719-635-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty