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General NPI Number Information
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NPI Number | 1972061679
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL ASSOCIATES OF LEESBURG, LLC
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 106 W NORTH BLVD STE 102
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City | LEESBURG
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State | FL
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Zip | 34748-5039
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Country | US
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Telephone | 352-702-4340
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Fax |
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Provider Business Mailing Address
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Address Line | 425 ALEXANDRIA BLVD STE 1000
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City | OVIEDO
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State | FL
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Zip | 32765-5548
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Country | US
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Telephone | 407-977-3434
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARC OTT
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Credential | DC
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Telephone | 352-702-4340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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