Provider Demographics
NPI:1912363383
Name:INTEGRATIVE PHYSICAL MEDICINE OF MAITLAND, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL MEDICINE OF MAITLAND, LLC
Other - Org Name:INTEGRATIVE PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEUPLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-839-1045
Mailing Address - Street 1:7984 FOREST CITY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-2907
Mailing Address - Country:US
Mailing Address - Phone:407-502-3545
Mailing Address - Fax:407-502-3503
Practice Address - Street 1:7984 FOREST CITY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-2907
Practice Address - Country:US
Practice Address - Phone:407-502-3545
Practice Address - Fax:407-502-3503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATIVE PHYSICAL MEDICINE HOLDING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty