Provider Demographics
NPI:1669778510
Name:FLAGSTAFF INTEGRATED THERAPIES LLC
Entity type:Organization
Organization Name:FLAGSTAFF INTEGRATED THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER&OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WITTEKIND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:928-774-4111
Mailing Address - Street 1:1515 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-4923
Mailing Address - Country:US
Mailing Address - Phone:928-774-4111
Mailing Address - Fax:888-607-4763
Practice Address - Street 1:1515 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-4923
Practice Address - Country:US
Practice Address - Phone:928-774-4111
Practice Address - Fax:888-607-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6167261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy