Healthcare Provider Details

I. General information

NPI: 1477048320
Provider Name (Legal Business Name): INTEGRATIVE HEALTH AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2018
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 EXECUTIVE PARK DR STE 135
CINCINNATI OH
45241-4013
US

IV. Provider business mailing address

PO BOX 18337
CINCINNATI OH
45218-0337
US

V. Phone/Fax

Practice location:
  • Phone: 513-742-2669
  • Fax:
Mailing address:
  • Phone: 513-742-2669
  • Fax: 513-488-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAMEEL MIKAL MOKSA BATTLE
Title or Position: DIRECTOR
Credential: PT, AT, DIPL. OM
Phone: 513-349-4665