Provider Demographics
NPI:1295758373
Name:INTROCELL LLC
Entity type:Organization
Organization Name:INTROCELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAR-INFRARED THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-941-4470
Mailing Address - Street 1:2400 W MICHIGAN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-2200
Mailing Address - Country:US
Mailing Address - Phone:850-941-4470
Mailing Address - Fax:850-941-4471
Practice Address - Street 1:2400 W MICHIGAN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-2200
Practice Address - Country:US
Practice Address - Phone:850-941-4470
Practice Address - Fax:850-941-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFIT-001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFIT-001OtherFAR-INFRARED THERAPIST