Provider Demographics
NPI:1255581955
Name:INTEGRATED THERAPIES, LLC
Entity type:Organization
Organization Name:INTEGRATED THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP, CPT
Authorized Official - Phone:360-379-1373
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0182
Mailing Address - Country:US
Mailing Address - Phone:360-379-1373
Mailing Address - Fax:
Practice Address - Street 1:22 TAHLEQUAH RD
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9700
Practice Address - Country:US
Practice Address - Phone:360-379-1373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty