Provider Demographics
NPI:1699863530
Name:INTEGRATED PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:602-374-2760
Mailing Address - Street 1:20815 N 25TH PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4608
Mailing Address - Country:US
Mailing Address - Phone:602-374-2760
Mailing Address - Fax:602-354-8184
Practice Address - Street 1:20815 N 25TH PL
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4608
Practice Address - Country:US
Practice Address - Phone:602-374-2760
Practice Address - Fax:602-354-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3984261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS83619Medicare UPIN