Integrative Physical Medicine of Lake Mary LLC

NPI #1487907010 in Lake Mary, Florida

Provider Information

NPI Number: 1487907010
Entity Type: Organization
Organization Name: Integrative Physical Medicine of Lake Mary LLC
Primary Specialty: Specialist
Enumeration Date: Oct 19, 2012
Last Updated: Nov 20, 2012

Practice Location

Address: 1343 S INTERNATIONAL PKWY
Address 2: SUITE 1351-B
City: Lake Mary
State: Florida
ZIP Code: 32746-1401
Phone: (407) 792-0705

Authorized Official

Name: MARC OTT
Title: PRESIDENT
Phone: (407) 977-3434

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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