Provider Demographics
NPI:1245748052
Name:INTEGRATIVE PHYSICAL MEDICINE OF METRO WEST LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL MEDICINE OF METRO WEST LLC
Other - Org Name:INTEGRATIVE PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:GENTER
Authorized Official - Last Name:SCHEUPLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-221-6690
Mailing Address - Street 1:1743 PARK CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7621
Mailing Address - Country:US
Mailing Address - Phone:407-440-0844
Mailing Address - Fax:407-440-9766
Practice Address - Street 1:1743 PARK CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7621
Practice Address - Country:US
Practice Address - Phone:407-440-0844
Practice Address - Fax:407-440-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty