Provider Demographics
NPI:1841375086
Name:INTEGRATED PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-265-2230
Mailing Address - Street 1:357 S GULPH RD STE 310
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3136
Mailing Address - Country:US
Mailing Address - Phone:610-265-2230
Mailing Address - Fax:
Practice Address - Street 1:357 S GULPH RD STE 310
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3136
Practice Address - Country:US
Practice Address - Phone:610-265-2230
Practice Address - Fax:610-265-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013857L2251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA084860Medicare ID - Type UnspecifiedLGRELLO MEDICARE ID
PA084861TDTMedicare ID - Type UnspecifiedMEDICARE GROUP ID