Provider Demographics
NPI:1861757023
Name:INTEGRATIVE THERAPEUTICS LLC
Entity type:Organization
Organization Name:INTEGRATIVE THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENILE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABELL
Authorized Official - Suffix:
Authorized Official - Credentials:FN P
Authorized Official - Phone:317-826-0096
Mailing Address - Street 1:11074 WOODS BAY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9020
Mailing Address - Country:US
Mailing Address - Phone:317-703-4772
Mailing Address - Fax:
Practice Address - Street 1:11074 WOODS BAY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9020
Practice Address - Country:US
Practice Address - Phone:317-703-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002899B261QM2500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty