Provider Demographics
NPI:1477048320
Name:INTEGRATIVE HEALTH AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMEEL
Authorized Official - Middle Name:MIKAL
Authorized Official - Last Name:MOKSA BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, AT, DIPL OM
Authorized Official - Phone:513-446-1906
Mailing Address - Street 1:PO BOX 18337
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45218-0337
Mailing Address - Country:US
Mailing Address - Phone:513-446-1906
Mailing Address - Fax:
Practice Address - Street 1:9403 KENWOOD RD STE B102
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6829
Practice Address - Country:US
Practice Address - Phone:513-446-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-23
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0360068Medicaid