Provider Demographics
NPI:1841707635
Name:INTEGRAL THERAPY CENTER
Entity type:Organization
Organization Name:INTEGRAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:787-247-0570
Mailing Address - Street 1:H31 CALLE AMAPOLA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3345
Mailing Address - Country:US
Mailing Address - Phone:787-247-0570
Mailing Address - Fax:
Practice Address - Street 1:URB RADIOVILLE AVE RAFAEL COLON CASTRO
Practice Address - Street 2:SUITE 2
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-439-8894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X
PR1045261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1821363441Medicaid