Healthcare Provider Details

I. General information

NPI: 1225073315
Provider Name (Legal Business Name): SARASOTA PHYSICAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 WEBBER ST
SARASOTA FL
34232-4412
US

IV. Provider business mailing address

3687 WEBBER ST
SARASOTA FL
34232-4412
US

V. Phone/Fax

Practice location:
  • Phone: 941-922-9312
  • Fax: 941-927-8731
Mailing address:
  • Phone: 941-922-9312
  • Fax: 941-927-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCH7627
License Number StateFL

VIII. Authorized Official

Name: MICHELE LAMOURT
Title or Position: PRESIDENT
Credential: D.C.
Phone: 941-922-9312