Provider Demographics
NPI:1699424374
Name:INTEGRATIVE MEDICINE & REHAB LLC
Entity type:Organization
Organization Name:INTEGRATIVE MEDICINE & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:MONTEZ
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-208-0088
Mailing Address - Street 1:9101 W COLLEGE POINTE DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3390
Mailing Address - Country:US
Mailing Address - Phone:239-208-0088
Mailing Address - Fax:
Practice Address - Street 1:9101 W COLLEGE POINTE DR STE 1B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3390
Practice Address - Country:US
Practice Address - Phone:239-208-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center