Organization
INTEGRA THERAPEUTIC MASSAGE, LLC
Active
Other names
INTEGRA PHYSICAL THERAPY AND MASSAGE
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DARLENE TAN ESQ (ADMINISTRATOR)
(904) 612-4588
Entity
Organization
Contact information
Practice address
1871 WELLS RD STE 300, ORANGE PARK, FL 32073-2350
(904) 612-4588
(904) 260-3011
Mailing address
8257 SEVEN MILE DR, PONTE VEDRA BEACH, FL 32082-3132
(904) 612-4588
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174800221
—
FL
05
—
1285070532
—
FL
01
—
PT10897
STATE OF FLORIDA DEPARTMENT OF HEALTH
FL
01
—
PT6934
STATE OF FLORIDA DEPARTMENT OF HEALTH
FL
01
—
PT8535
STATE OF FLORIDA DEPARTMENT OF HEALTH
FL
01
—
PTA27875
STATE OF FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
09/17/2020
Last updated
09/18/2020
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