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General NPI Number Information
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NPI Number | 1740880822
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE SOMATIC TRAUMA THERAPY
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 45 GRAND ST APT 4
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2268
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Country | US
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Telephone | 207-815-0371
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Fax |
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Provider Business Mailing Address
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Address Line | 45 GRAND ST APT 4
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2268
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Country | US
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Telephone | 207-815-0371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS GALE KURTZ
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Credential |
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Telephone | 207-815-0371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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