Healthcare Provider Details

I. General information

NPI: 1952777039
Provider Name (Legal Business Name): INTEGRATIVE PHYSICAL MEDICINE OF DAYTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 YANKEE PARK PL
CENTERVILLE OH
45458-1878
US

IV. Provider business mailing address

1504 YANKEE PARK PL
CENTERVILLE OH
45458-1878
US

V. Phone/Fax

Practice location:
  • Phone: 937-424-3068
  • Fax:
Mailing address:
  • Phone: 937-424-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIM DOOLEY
Title or Position: PRESIDENT
Credential: DC
Phone: 937-424-3068