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General NPI Number Information
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NPI Number | 1205140654
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Entity Type | Organization
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Legal Business Name | INTEGRATED PHYSIOTHERAPY, INC.
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 4460 N CHESTNUT ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3813
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Country | US
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Telephone | 719-635-7844
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Fax |
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Provider Business Mailing Address
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Address Line | 21 GRANT AVE
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City | MANITOU SPRINGS
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State | CO
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Zip | 80829-1819
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Country | US
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Telephone | 719-685-4779
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DIANE D MASSIK
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Credential | P.T.
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Telephone | 719-635-7844
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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 | 5363
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License Number State | CO
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