Healthcare Provider Details

I. General information

NPI: 1669488334
Provider Name (Legal Business Name): INTEGRATED MEDICAL THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 11TH CIR STE 108
VERO BEACH FL
32960-4838
US

IV. Provider business mailing address

3745 11TH CIR STE 108
VERO BEACH FL
32960-4838
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-1552
  • Fax: 772-567-5269
Mailing address:
  • Phone: 772-567-1552
  • Fax: 772-567-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM KREBS
Title or Position: OFFICE MANAGER/BILLING SPECIALIST
Credential: CPEDC
Phone: 772-567-1552