Provider Demographics
NPI:1760810238
Name:INTEGRATIVE HEALTH & ALTERNATIVE PAIN CENTER, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH & ALTERNATIVE PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:321-946-5153
Mailing Address - Street 1:195 S WESTMONTE DR
Mailing Address - Street 2:SUITE 1120
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4266
Mailing Address - Country:US
Mailing Address - Phone:407-862-8834
Mailing Address - Fax:407-862-5951
Practice Address - Street 1:195 S WESTMONTE DR
Practice Address - Street 2:SUITE 1120
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4266
Practice Address - Country:US
Practice Address - Phone:407-862-8834
Practice Address - Fax:407-862-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty