MEDICARE: INTEGRATIVE THERAPIES, INC.

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	133VN1006X	Metabolic Nutrition Registered Dietitian
2	225100000X	Physical Therapist	NC1307	NC

General Provider Information

NPI Number	:	1043278195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE THERAPIES, INC.

Provider Business Mailing Address
First Line	:	4112 SPRING GARDEN ST STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1652
Country	:	US
Telephone Number	:	336-294-0910
Fax Number	:	336-218-0294

Provider Business Practice Location Address
First Line	:	4112 SPRING GARDEN ST STE A
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1652
Country	:	US
Telephone Number	:	336-294-0910
Fax Number	:	336-218-0294

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. NANCY KIM COFFIN
Credential	:
Telephone Number	:	336-254-0910

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	09/26/2024

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