Provider Demographics
NPI:1225073315
Name:SARASOTA PHYSICAL MEDICINE INC
Entity Type:Organization
Organization Name:SARASOTA PHYSICAL MEDICINE INC
Other - Org Name:HALEY LAMOURT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOURT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-922-9312
Mailing Address - Street 1:3687 WEBBER ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-4412
Mailing Address - Country:US
Mailing Address - Phone:941-922-9312
Mailing Address - Fax:941-927-8731
Practice Address - Street 1:3687 WEBBER ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-4412
Practice Address - Country:US
Practice Address - Phone:941-922-9312
Practice Address - Fax:941-927-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7627111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74824OtherBCBS
FL381346100Medicaid
FL6314530001Medicare NSC
FL55644ZMedicare ID - Type UnspecifiedGROUP NUMBER
FL55814ZMedicare ID - Type UnspecifiedGROUP NUMBER
FLK6579Medicare ID - Type UnspecifiedGROUP NUMBER