Organization
INTEGRATED THERAPY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SILLEVIS PT (OWNER)
(219) 531-1756
Entity
Organization
Contact information
Practice address
1265 S LAKE PARK AVE, HOBART, IN 46342-5961
(219) 531-1756
(219) 531-1759
Mailing address
1265 S LAKE PARK AVE, HOBART, IN 46342-5961
(219) 531-1756
(219) 531-1759
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000372620
ANTHEM
IN
05
—
200346180
—
IN
01
—
90001194
BC/BS
IL
01
—
Y90R3
BCBS FLORIDA
FL
Enumeration date
07/11/2006
Last updated
09/27/2012
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