MEDICARE: INTEGRATIVE THERAPEUTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1538168026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE THERAPEUTICS, INC.

Provider Business Mailing Address
First Line	:	220 N MAIN ST STE 101
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-1100
Country	:	US
Telephone Number	:	508-647-3200
Fax Number	:	508-647-0902

Provider Business Practice Location Address
First Line	:	220 N MAIN ST STE 101
Second Line	:
City	:	NATICK
State	:	MA
Zip	:	01760-1100
Country	:	US
Telephone Number	:	508-647-3200
Fax Number	:	508-647-0902

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TODD FORMAN
Credential	:	PT
Telephone Number	:	508-647-3200

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	09/03/2025

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