Provider Demographics
NPI:1407673288
Name:INTENTIONAL CONNECTIONS LLC
Entity type:Organization
Organization Name:INTENTIONAL CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / MFR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDA COCKING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-300-5155
Mailing Address - Street 1:1451 W CYPRESS CREEK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1953
Mailing Address - Country:US
Mailing Address - Phone:954-300-5155
Mailing Address - Fax:
Practice Address - Street 1:1451 W CYPRESS CREEK RD STE 337
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1961
Practice Address - Country:US
Practice Address - Phone:954-300-5155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service