Provider Demographics
NPI:1083248918
Name:INNOVATIVE SWALLOWING & THERAPEUTICS LLC
Entity Type:Organization
Organization Name:INNOVATIVE SWALLOWING & THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEURIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:334-558-8579
Mailing Address - Street 1:150 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4906
Mailing Address - Country:US
Mailing Address - Phone:334-558-8579
Mailing Address - Fax:
Practice Address - Street 1:150 MARKET PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4906
Practice Address - Country:US
Practice Address - Phone:334-558-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)