Provider Demographics
NPI:1295913143
Name:INTEGRATED THERAPIES INC
Entity type:Organization
Organization Name:INTEGRATED THERAPIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VAN RIJ
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, LAC
Authorized Official - Phone:386-451-2781
Mailing Address - Street 1:454 LEEWAY TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2563
Mailing Address - Country:US
Mailing Address - Phone:386-451-2781
Mailing Address - Fax:386-671-2113
Practice Address - Street 1:1450 N US HIGHWAY 1
Practice Address - Street 2:SUITE 900
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6622
Practice Address - Country:US
Practice Address - Phone:386-671-2112
Practice Address - Fax:386-671-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-02
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1788171100000X
FLPT 8620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4473Medicare PIN