Provider Demographics
NPI:1336532613
Name:INTEGRATIVE THERAPY SERVICES LLS
Entity Type:Organization
Organization Name:INTEGRATIVE THERAPY SERVICES LLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LANDON
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-839-4741
Mailing Address - Street 1:50 SKIN ALLEY SUITE 4
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071
Mailing Address - Country:US
Mailing Address - Phone:678-404-7605
Mailing Address - Fax:
Practice Address - Street 1:50 SKIN ALLEY SUITE 4
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:678-404-7605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010554261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy