Provider Demographics
NPI:1396894770
Name:NEUROMUSCULAR THERAPY CENTER INC
Entity type:Organization
Organization Name:NEUROMUSCULAR THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VP
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-312-6142
Mailing Address - Street 1:PO BOX 19227
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34276-2227
Mailing Address - Country:US
Mailing Address - Phone:941-312-6142
Mailing Address - Fax:941-993-1520
Practice Address - Street 1:7222 S TAMIAMI TRL STE 105
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5569
Practice Address - Country:US
Practice Address - Phone:941-312-6142
Practice Address - Fax:941-993-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K1768Medicare UPIN
FLK1768Medicare ID - Type UnspecifiedGROUP #