Provider Demographics
NPI:1154370120
Name:INTEGRATED THERAPY PRACTICE
Entity type:Organization
Organization Name:INTEGRATED THERAPY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:866-945-1538
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-0261
Mailing Address - Country:US
Mailing Address - Phone:219-476-0352
Mailing Address - Fax:
Practice Address - Street 1:1265 S LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5961
Practice Address - Country:US
Practice Address - Phone:866-945-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
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
IN216000FMedicare ID - Type Unspecified