Healthcare Provider Details

I. General information

NPI: 1477806594
Provider Name (Legal Business Name): INTEGRATED CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N LOOP 288 SUITE 120
DENTON TX
76209-4809
US

IV. Provider business mailing address

400 N LOOP 288 SUITE 120
DENTON TX
76209-4809
US

V. Phone/Fax

Practice location:
  • Phone: 940-566-3599
  • Fax: 866-929-0361
Mailing address:
  • Phone: 940-566-3599
  • Fax: 866-929-0361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberP3183
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA02285
License Number StateTX

VIII. Authorized Official

Name: ROBERT T HOWELL
Title or Position: OWNER
Credential: DC, DVM
Phone: 940-566-3599