Healthcare Provider Details

I. General information

NPI: 1609226059
Provider Name (Legal Business Name): INTEGRATIVE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 COURT AVE
BAKER CITY OR
97814-3445
US

IV. Provider business mailing address

1928 COURT AVE
BAKER CITY OR
97814-3445
US

V. Phone/Fax

Practice location:
  • Phone: 541-523-9664
  • Fax: 541-523-9665
Mailing address:
  • Phone: 541-523-9664
  • Fax: 541-523-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number03918
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1265459093
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerINDIVIDUAL NPI

VIII. Authorized Official

Name: ANNE NEMEC
Title or Position: OWNER
Credential:
Phone: 541-523-9664