MEDICARE: INTERNATIONAL NEUROMUSCULAR THERAPY I, INC.

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	225700000X	Massage Therapist	MM11141	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MM 11141	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH DIVISION OF QUALITY ASSURANCE

General Provider Information

NPI Number	:	1821488057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL NEUROMUSCULAR THERAPY I, INC.

Provider Business Mailing Address
First Line	:	201 SE 15TH TER
Second Line	:	SUITE 212
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4464
Country	:	US
Telephone Number	:	561-642-1408
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SE 15TH TER
Second Line	:	SUITE 212
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4464
Country	:	US
Telephone Number	:	561-642-1408
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	ILANA FAITH SPODAK
Credential	:	L.M.T., C.N.M.T
Telephone Number	:	561-642-1408

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	03/04/2015

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