| Organization Name: | INTEGRA PHYSICAL THERAPY,SC |
| NPI Number: | 1417221433 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN HERDA (CFO) |
| Mailing Address: | 8677 N Port Washington Rd Fox Point |
| State: | WI US |
| Postal Code: | 532172209 |
| Phone Number: | 4143518482 |
| Fax Number: | 4143518483 |
| NPI Enumeration Date: | 03/08/2012 |
| NPI Last Update Date: | 04/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 9931 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |