Provider Demographics
NPI:1538168026
Name:INTEGRATIVE THERAPEUTICS, INC.
Entity type:Organization
Organization Name:INTEGRATIVE THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-647-3200
Mailing Address - Street 1:214 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1131
Mailing Address - Country:US
Mailing Address - Phone:508-647-3200
Mailing Address - Fax:508-647-0902
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1131
Practice Address - Country:US
Practice Address - Phone:508-647-3200
Practice Address - Fax:508-647-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAIN-PT0144Medicare ID - Type UnspecifiedMEDICARE PT GROUP NUMBER