Provider Demographics
NPI:1245294917
Name:INTEGRATED MANUAL THERAPY, LLC
Entity type:Organization
Organization Name:INTEGRATED MANUAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC
Authorized Official - Phone:206-362-5255
Mailing Address - Street 1:18021 15TH AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3809
Mailing Address - Country:US
Mailing Address - Phone:206-362-5255
Mailing Address - Fax:206-362-5260
Practice Address - Street 1:18021 15TH AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-3809
Practice Address - Country:US
Practice Address - Phone:206-362-5255
Practice Address - Fax:206-362-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000050302251X0800X
WAPT000030392251X0800X
WAPT000007352251X0800X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty