MEDICARE: INTEGRATIVE PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1013670512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	8 BEAVERBROOK HL
Second Line	:
City	:	UNDERHILL
State	:	VT
Zip	:	05489-9433
Country	:	US
Telephone Number	:	541-514-0955
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 SAINT PAUL ST STE 321
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-5073
Country	:	US
Telephone Number	:	802-557-1349
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE DOWNING
Credential	:	DPT
Telephone Number	:	541-514-9555

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	04/06/2022

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