Provider Demographics
NPI:1699318261
Name:INTEGRATE PHYSICAL THERAPY, BODYWORK AND WELLNESS
Entity type:Organization
Organization Name:INTEGRATE PHYSICAL THERAPY, BODYWORK AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTACIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-702-2921
Mailing Address - Street 1:18170 NW PARK VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3338
Mailing Address - Country:US
Mailing Address - Phone:503-702-2921
Mailing Address - Fax:
Practice Address - Street 1:1975 NW 167TH PL STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4908
Practice Address - Country:US
Practice Address - Phone:503-702-2921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy