Provider Demographics
NPI:1871980656
Name:INTEGRATIVE PHYSICAL MEDICINE OF KISSIMMEE LLC.
Entity type:Organization
Organization Name:INTEGRATIVE PHYSICAL MEDICINE OF KISSIMMEE LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:GENTER
Authorized Official - Last Name:SCHEUPLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-624-5808
Mailing Address - Street 1:222 BROADWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5781
Mailing Address - Country:US
Mailing Address - Phone:407-624-5808
Mailing Address - Fax:407-624-5803
Practice Address - Street 1:222 BROADWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5781
Practice Address - Country:US
Practice Address - Phone:407-624-5808
Practice Address - Fax:407-624-5803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATIVE PHYSICAL MEDICINE HOLDING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-20
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty