Provider Demographics
NPI:1164830287
Name:ACUTE INTEGRATIVE MEDICAL THERAPIES
Entity Type:Organization
Organization Name:ACUTE INTEGRATIVE MEDICAL THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:352-383-0004
Mailing Address - Street 1:428 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5663
Mailing Address - Country:US
Mailing Address - Phone:352-383-0004
Mailing Address - Fax:352-735-8637
Practice Address - Street 1:428 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5663
Practice Address - Country:US
Practice Address - Phone:352-383-0004
Practice Address - Fax:352-735-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1376302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization