Provider Demographics
NPI:1609828482
Name:INTEGRATED MEDICAL REHABILITATION OF FL, LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL REHABILITATION OF FL, LLC
Other - Org Name:INTEGRATED MEDICAL REHAB AND TESTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-447-8219
Mailing Address - Street 1:3924 9TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1704
Mailing Address - Country:US
Mailing Address - Phone:941-447-8219
Mailing Address - Fax:941-747-1461
Practice Address - Street 1:3924 9TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1704
Practice Address - Country:US
Practice Address - Phone:941-447-8219
Practice Address - Fax:941-747-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-4587Medicare ID - Type Unspecified