Provider Demographics
NPI:1265568281
Name:INTEGRATIVE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:INTEGRATIVE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SEGNERE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-453-4321
Mailing Address - Street 1:37 SOUNDVIEW RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2916
Mailing Address - Country:US
Mailing Address - Phone:203-453-4321
Mailing Address - Fax:203-453-4322
Practice Address - Street 1:37 SOUNDVIEW RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2916
Practice Address - Country:US
Practice Address - Phone:203-453-4321
Practice Address - Fax:203-453-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03670Medicare ID - Type Unspecified