MEDICARE: INTEGRA PHYSICAL THERAPY,SC

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	9931	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417221433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRA PHYSICAL THERAPY,SC

Provider Business Mailing Address
First Line	:	8677 N PORT WASHINGTON RD
Second Line	:
City	:	FOX POINT
State	:	WI
Zip	:	53217-2209
Country	:	US
Telephone Number	:	414-351-8482
Fax Number	:	414-351-8483

Provider Business Practice Location Address
First Line	:	8677 N PORT WASHINGTON RD
Second Line	:
City	:	FOX POINT
State	:	WI
Zip	:	53217-2209
Country	:	US
Telephone Number	:	414-351-8482
Fax Number	:	414-351-8483

Authorized Official
Title or Position	:	CFO
Name	:	JOHN HERDA
Credential	:
Telephone Number	:	414-351-8482

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	04/08/2013

Similar Medicare Providers

1750334041 — ERIK KRISTOPHER BORK DP T
Practice Location Address:

8677 N PORT WASHINGTON RD
FOX POINT, WI
53217-2209

Practice Phone: 414-351-8482
Practice Fax:

1356382220 — WISCONSIN CVS PHARMACY LLC
Practice Location Address:

8661 N PORT WASHINGTON RD
FOX POINT, WI
53217-2209

Practice Phone: 414-540-6836
Practice Fax:

1346357761 — MS. MARY K MURPHY APNP
Practice Location Address:

8675 N PORT WASHINGTON RD
FOX POINT, WI
53217-2209

Practice Phone: 414-352-2011
Practice Fax: 414-351-7324

1992087746 — DR. JEREMIAH ARTHUR WEBER DPT
Practice Location Address:

8677 N PORT WASHINGTON RD
FOX POINT, WI
53217-2209

Practice Phone: 414-351-8482
Practice Fax: 414-351-8483

1215344718 — STEPHANIE SMITH DPT
Practice Location Address:

8677 N PORT WASHINGTON RD
FOX POINT, WI
53217-2209

Practice Phone: 414-351-8482
Practice Fax: 414-351-8483

1467817676 — MS. SHAMARIA LATRICE WOOTEN-BOSTON
Practice Location Address:

8661 N PORT WASHINGTON RD
FOX POINT, WI
53217-2209

Practice Phone: 866-389-2727
Practice Fax:

Directions to “INTEGRA PHYSICAL THERAPY,SC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.