MEDICARE: INTEGRATIVE PHYSICAL MEDICINE OF METRO WEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1245748052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE PHYSICAL MEDICINE OF METRO WEST LLC

Provider Business Mailing Address
First Line	:	1743 PARK CENTER DR STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-7621
Country	:	US
Telephone Number	:	407-440-0844
Fax Number	:	407-440-9766

Provider Business Practice Location Address
First Line	:	1743 PARK CENTER DR STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-7621
Country	:	US
Telephone Number	:	407-440-0844
Fax Number	:	407-440-9766

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRET GENTER SCHEUPLEIN
Credential	:	DC
Telephone Number	:	407-221-6690

Provider Enumeration Date	:	01/15/2018
Last Update Date	:	09/10/2018

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