Provider Demographics
NPI:1700141975
Name:INTEGRATIVE PHYSICAL MEDICINE, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-929-3700
Mailing Address - Street 1:1936 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9262
Mailing Address - Country:US
Mailing Address - Phone:813-929-3700
Mailing Address - Fax:813-929-3711
Practice Address - Street 1:1722 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8640
Practice Address - Country:US
Practice Address - Phone:813-929-3700
Practice Address - Fax:813-929-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty