Provider Demographics
NPI: | 1740331354 |
---|---|
Name: | INTEGRATED THERAPY SERVICES, LLC |
Entity type: | Organization |
Organization Name: | INTEGRATED THERAPY SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO/OTR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AUGUSTO |
Authorized Official - Middle Name: | IVAN |
Authorized Official - Last Name: | ARANGUREN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS OTR/L CST C/NDT |
Authorized Official - Phone: | 520-981-0166 |
Mailing Address - Street 1: | P.O. BOX 42173 |
Mailing Address - Street 2: | |
Mailing Address - City: | TUCSON |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85733-2173 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 520-471-0283 |
Mailing Address - Fax: | 520-327-5182 |
Practice Address - Street 1: | 3920 E 5TH ST |
Practice Address - Street 2: | |
Practice Address - City: | TUCSON |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85711-1917 |
Practice Address - Country: | US |
Practice Address - Phone: | 520-471-0283 |
Practice Address - Fax: | 520-327-5182 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-12 |
Last Update Date: | 2022-10-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
1744G0900X, 2081P0010X, 224Z00000X, 225100000X, 225700000X, 2355S0801X, 235Z00000X, 261QX0100X | ||
AZ | 4668 | 225X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
No | 1744G0900X | Other Service Providers | Specialist | Graphics Designer | Group - Single Specialty |
No | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Single Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Single Specialty | |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Single Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 595093 | Other | AHCCCS |
AZ | 841967 | Other | AHCCCS |
AZ | 563398 | Other | AHCCCS |
AZ | 164737 | Other | AHCCCS |
AZ | 801119 | Other | AHCCCS |