Provider Demographics
NPI:1821488057
Name:INTERNATIONAL NEUROMUSCULAR THERAPY I, INC.
Entity Type:Organization
Organization Name:INTERNATIONAL NEUROMUSCULAR THERAPY I, INC.
Other - Org Name:MUSCULAR REHABILITATION CENTER OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ILANA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:SPODAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CNMT
Authorized Official - Phone:561-642-1408
Mailing Address - Street 1:201 SE 15TH TER
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4464
Mailing Address - Country:US
Mailing Address - Phone:561-642-1408
Mailing Address - Fax:
Practice Address - Street 1:201 SE 15TH TER
Practice Address - Street 2:SUITE 212
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4464
Practice Address - Country:US
Practice Address - Phone:561-642-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM11141225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM 11141OtherFLORIDA DEPARTMENT OF HEALTH DIVISION OF QUALITY ASSURANCE