Provider Demographics
NPI:1861848129
Name:INTEGRATIVE THERAPEUTIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:INTEGRATIVE THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIEL
Authorized Official - Middle Name:CASTANEDA
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:253-514-6842
Mailing Address - Street 1:5500 OLYMPIC DR STE H105
Mailing Address - Street 2:#101
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1491
Mailing Address - Country:US
Mailing Address - Phone:253-514-6842
Mailing Address - Fax:253-514-6863
Practice Address - Street 1:5775 SOUNDVIEW DR
Practice Address - Street 2:A-103
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2211
Practice Address - Country:US
Practice Address - Phone:253-651-3421
Practice Address - Fax:253-514-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603406965261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8946103OtherMEDICARE PTAN