Provider Demographics
NPI:1790038958
Name:INFRASTRUCTURED INSTITUTE, LLC
Entity Type:Organization
Organization Name:INFRASTRUCTURED INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:KINESIOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISEATI
Authorized Official - Suffix:
Authorized Official - Credentials:AADP
Authorized Official - Phone:301-230-3131
Mailing Address - Street 1:4701 RANDOLPH ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-230-3131
Mailing Address - Fax:
Practice Address - Street 1:4701 RANDOLPH ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-230-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty