Healthcare Provider Details

I. General information

NPI: 1699863530
Provider Name (Legal Business Name): INTEGRATED PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20815 N 25TH PL SUITE 100
PHOENIX AZ
85050-4608
US

IV. Provider business mailing address

20815 N 25TH PL SUITE 100
PHOENIX AZ
85050-4608
US

V. Phone/Fax

Practice location:
  • Phone: 602-374-2760
  • Fax: 602-354-8184
Mailing address:
  • Phone: 602-374-2760
  • Fax: 602-354-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3984
License Number StateAZ

VIII. Authorized Official

Name: MR. JEFFREY LEE EATON
Title or Position: OWNER
Credential: MPT
Phone: 602-374-2760