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General NPI Number Information
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NPI Number | 1598588345
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Entity Type | Organization
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Legal Business Name | I3M WELLNESS LLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 07/20/2025
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Provider Practice Location Address
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Address Line | 428 EDGE AVE
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City | VALPARAISO
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State | FL
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Zip | 32580-1090
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Country | US
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Telephone | 850-300-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 216 TRISH DR
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City | CRESTVIEW
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State | FL
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Zip | 32536-6454
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Country | US
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Telephone | 931-802-9137
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ISSAC B MYERS
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Credential | LMT
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Telephone | 850-270-7055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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