Provider Demographics
NPI:1477272029
Name:EASTERN MODALITIES, LLC
Entity Type:Organization
Organization Name:EASTERN MODALITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LMT, CMLDT
Authorized Official - Phone:407-274-5145
Mailing Address - Street 1:18739 NATCHEZ ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-4108
Mailing Address - Country:US
Mailing Address - Phone:407-274-5145
Mailing Address - Fax:
Practice Address - Street 1:18739 NATCHEZ ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-4108
Practice Address - Country:US
Practice Address - Phone:407-274-5145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty