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General NPI Number Information
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NPI Number | 1538534110
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MYOFUNCTIONAL THERAPY, INC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 210 E FIG ST STE 201
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City | FALLBROOK
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State | CA
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Zip | 92028-2889
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Country | US
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Telephone | 760-689-4008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | FALLBROOK
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State | CA
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Zip | 92088-0100
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Country | US
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Telephone | 760-689-4008
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VICTORIA L WRIGHT
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Credential |
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Telephone | 760-689-4008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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