Provider Demographics
NPI:1205387891
Name:MUSCLE INJECTION THERAPIES OF THE TREASURE COAST LLC
Entity Type:Organization
Organization Name:MUSCLE INJECTION THERAPIES OF THE TREASURE COAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-882-1632
Mailing Address - Street 1:201 NW SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1291
Mailing Address - Country:US
Mailing Address - Phone:772-882-1632
Mailing Address - Fax:
Practice Address - Street 1:201 NW SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1291
Practice Address - Country:US
Practice Address - Phone:772-882-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty