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General NPI Number Information
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NPI Number | 1609828482
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL REHABILITATION OF FL, LLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3924 9TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-1704
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Country | US
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Telephone | 941-447-8219
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Fax | 941-747-1461
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Provider Business Mailing Address
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Address Line | 3924 9TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-1704
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Country | US
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Telephone | 941-447-8219
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Fax | 941-747-1461
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Authorized Official
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Title or Position | PRESIDENT/MANAGING MEMBER
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Name | MS. DIANE B. LISCH
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Credential |
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Telephone | 941-447-8219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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