Integra Therapeutic Massage, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

INTEGRA THERAPEUTIC MASSAGE, LLC

Practice address

1871 Wells Rd Ste 300
Orange Park, FL 32073-2350

Phone

(904) 612-4588

Fax

(904) 260-3011

NPI assigned

Sep 17, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Darlene Tan, ESQNPI 1336912963

Title

Administrator

Phone

(904) 612-4588

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• INTEGRA PHYSICAL THERAPY AND MASSAGE Doing business as

Electronic endpoints 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darlene Tan, LMT

  • Massage Therapist
  • Jacksonville, FL
  • NPI 1336912963
  NPD (past) Authorized official
• Virginie Balisi, RPT

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1598538126
  NPD (past)
• Christopher Griffin, PTA

  • Physical Therapy Assistant
  • Jacksonville, FL
  • NPI 1770356222
  NPD (past)
• Cassandra Jennings, LMT, LPN

  • Licensed Practical Nurse
  • Jacksonville, FL
  • NPI 1518730142
  NPD (past)
• Jackson Chio Tan, M.D., PH.D., P.T.

  • Physical Medicine & Rehabilitation Physician
  • Jacksonville, FL
  • NPI 1649303934

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1376159178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8257 SEVEN MILE DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823132",
            "telephone_number": "904-612-4588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1871 WELLS RD STE 300",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732350",
            "telephone_number": "904-612-4588",
            "fax_number": "904-260-3011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2425 Dunn Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322184603",
            "country_code": "US",
            "telephone_number": "904-612-4588",
            "fax_number": "904-260-4849",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6144 Gazebo Park Pl S Ste 101",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322571086",
            "country_code": "US",
            "telephone_number": "904-612-4588",
            "fax_number": "904-260-4849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRA THERAPEUTIC MASSAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-612-4588",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ESQ"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "PT10897",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174800221",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285070532",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "PT6934",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "PT8535",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "PTA27875",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dtan.esq@comcast.net",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6144 Gazebo Park Pl S Ste 101",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322571086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "INTEGRA PHYSICAL THERAPY AND MASSAGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapy Clinic/Center in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Physical Therapy Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.