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General NPI Number Information
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NPI Number | 1538495718
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Entity Type | Organization
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Legal Business Name | IMPAKT LLC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 2636 W GRAND RESERVE CIR #927
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City | CLEARWATER
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State | FL
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Zip | 33759-4903
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Country | US
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Telephone | 727-492-5141
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4535
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City | CLEARWATER
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State | FL
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Zip | 33758-4535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KRISTIN NOEL ASHLEY
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Credential |
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Telephone | 727-492-5141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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