Organization
INTEGRA PHYSICAL THERAPY,SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HERDA (CFO)
(414) 351-8482
Entity
Organization
Contact information
Practice address
8677 N PORT WASHINGTON RD, FOX POINT, WI 53217-2209
(414) 351-8482
(414) 351-8483
Mailing address
8677 N PORT WASHINGTON RD, FOX POINT, WI 53217-2209
(414) 351-8482
(414) 351-8483
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
9931
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100024282
—
WI
Enumeration date
03/08/2012
Last updated
04/08/2013
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