Organization
INTEGRA THERAPEUTIC MASSAGE, LLC
Active
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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