Healthcare Provider Details

I. General information

NPI: 1689986135
Provider Name (Legal Business Name): INTEGRATED HEALTHCARE SERVICES PHYSICAL THERAPY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 FEE ANA ST #A
PLACENTIA CA
92870-6755
US

IV. Provider business mailing address

950 FEE ANA ST #A
PLACENTIA CA
92870-6755
US

V. Phone/Fax

Practice location:
  • Phone: 866-627-3907
  • Fax: 866-770-6589
Mailing address:
  • Phone: 866-627-3907
  • Fax: 866-770-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIM SNOW
Title or Position: OWNER
Credential:
Phone: 866-627-3907