Healthcare Provider Details

I. General information

NPI: 1902665847
Provider Name (Legal Business Name): INTENTIONAL HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 CHESSIE LN
HARPERS FERRY WV
25425-3086
US

IV. Provider business mailing address

441 CHESSIE LN
HARPERS FERRY WV
25425-3086
US

V. Phone/Fax

Practice location:
  • Phone: 626-540-2323
  • Fax:
Mailing address:
  • Phone: 706-429-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: TARA GARRISON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 706-429-6804