Provider Demographics
NPI:1790159507
Name:INTEGRATED PELVIC HEALTH AND REHABILITATION OF SOUTHWEST FLORIDA, P.A.
Entity Type:Organization
Organization Name:INTEGRATED PELVIC HEALTH AND REHABILITATION OF SOUTHWEST FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:VIA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:941-724-4653
Mailing Address - Street 1:5929 APPROACH RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5720
Mailing Address - Country:US
Mailing Address - Phone:941-724-4653
Mailing Address - Fax:941-444-7689
Practice Address - Street 1:5929 APPROACH RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5720
Practice Address - Country:US
Practice Address - Phone:941-724-4653
Practice Address - Fax:941-444-7689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL VIA THERAPY AND SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12074261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty