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General NPI Number Information
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NPI Number | 1154370120
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Entity Type | Organization
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Legal Business Name | INTEGRATED THERAPY PRACTICE
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1265 S LAKE PARK AVE
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City | HOBART
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State | IN
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Zip | 46342-5961
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Country | US
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Telephone | 866-945-1538
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261
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City | VALPARAISO
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State | IN
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Zip | 46384-0261
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Country | US
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Telephone | 219-476-0352
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/PRESIDENT
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Name | ROBERT SILLEVAS
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Credential | PT
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Telephone | 866-945-1538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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