Provider Demographics
NPI:1063930964
Name:INTEGRATIVE PHYSICAL MEDICINE OF PLANT CITY LLC
Entity type:Organization
Organization Name:INTEGRATIVE PHYSICAL MEDICINE OF PLANT CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-977-3434
Mailing Address - Street 1:1707 W REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4737
Mailing Address - Country:US
Mailing Address - Phone:386-401-9796
Mailing Address - Fax:386-401-9797
Practice Address - Street 1:1707 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4737
Practice Address - Country:US
Practice Address - Phone:386-401-9796
Practice Address - Fax:386-401-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty