Provider Demographics
NPI:1992272322
Name:STRUCTURAL THERAPEUTIC INTEGRATION, INC.
Entity type:Organization
Organization Name:STRUCTURAL THERAPEUTIC INTEGRATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMBTWNER
Authorized Official - Phone:352-638-0391
Mailing Address - Street 1:13024 YALE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-8956
Mailing Address - Country:US
Mailing Address - Phone:352-638-0391
Mailing Address - Fax:
Practice Address - Street 1:17521 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6737
Practice Address - Country:US
Practice Address - Phone:352-638-0391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty