Healthcare Provider Details

I. General information

NPI: 1780266577
Provider Name (Legal Business Name): INTEGRAL PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5641 IRIS PKWY UNIT D
FREDERICK CO
80504-6925
US

IV. Provider business mailing address

11169 E I25 FRONTAGE RD STE C
FIRESTONE CO
80504-5211
US

V. Phone/Fax

Practice location:
  • Phone: 720-600-0370
  • Fax: 720-600-0374
Mailing address:
  • Phone: 720-600-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER EDMUNDSON
Title or Position: PRESIDENT
Credential:
Phone: 720-600-0370