Provider Demographics
NPI:1881212470
Name:INTERACTIVE THERAPIES LLC
Entity Type:Organization
Organization Name:INTERACTIVE THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:913-484-0584
Mailing Address - Street 1:3138 DUNSTABLE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7949
Mailing Address - Country:US
Mailing Address - Phone:913-484-0584
Mailing Address - Fax:
Practice Address - Street 1:3138 DUNSTABLE DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7949
Practice Address - Country:US
Practice Address - Phone:913-484-0584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT28919OtherSTATE LICENSE