NPIMap

Organization Active NPI

Integrated Therapy Practice, PC

  • Physical Therapy Clinic/Center
  • Hobart, IN
National Provider Identifier
1922033083
Registry record updated Sep 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
INTEGRATED THERAPY PRACTICE, PC
Practice address
1265 S Lake Park Ave
Hobart, IN 46342-5961
Phone
(219) 531-1756
Fax
(219) 531-1759
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2012

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

Authorized official

Name
Robert Sillevis, PTNPI 1760413181
Title
Owner
Phone
(219) 531-1756

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1265 S Lake Park Ave
Hobart, IN 46342-5961

Mailing address

1265 S Lake Park Ave
Hobart, IN 46342-5961
Phone (219) 531-1756

Other identifiers 4

IdentifierTypeStateIssuer
000000372620OtherINANTHEM
200346180MedicaidIN
Y90R3OtherFLBCBS FLORIDA
90001194OtherILBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040628001129 IN Part B Supplier - Clinic/Group Practice 8628053402 Receives reassigned benefits from 1 practitioner
Practice locations: Merrillville, IN
O20120619000074 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8628053402 Receives reassigned benefits from 2 practitioners
Practice locations: Cape Coral, FL

National Provider Directory

National Provider Directory

Locations

3108 Santa Barbara Blvd
Ste 108
Cape Coral, FL 33914
Phone (239) 257-1431

20 Barkley Cir
Ste 103
Fort Myers, FL 33907
Phone (239) 245-7908

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1922033083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 S LAKE PARK AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463425961",
            "telephone_number": "219-531-1756",
            "fax_number": "219-531-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 S LAKE PARK AVE",
            "city": "HOBART",
            "state": "IN",
            "postal_code": "463425961",
            "telephone_number": "219-531-1756",
            "fax_number": "219-531-1759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED THERAPY PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "SILLEVIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "219-531-1756",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000372620",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200346180",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "Y90R3",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "90001194",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hobart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.