Integrative Physical Medicine of Lake Mary LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

INTEGRATIVE PHYSICAL MEDICINE OF LAKE MARY LLC

Practice address

1343 S International Pkwy
Lake Mary, FL 32746-1401

Phone

(407) 792-0705

Fax

(407) 792-0710

NPI assigned

Mar 19, 2014

Last updated

Jun 1, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

INTEGRATIVE PHYSICAL MEDICINE HOLDING LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marc Ott

Title

President

Phone

(407) 792-0705

Specialties & licenses 1

Addresses

Part of

Complete Care Centers

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1043637861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1343 S INTERNATIONAL PKWY",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461401",
            "telephone_number": "407-792-0705",
            "fax_number": "407-792-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 S INTERNATIONAL PKWY",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461401",
            "telephone_number": "407-792-0705",
            "fax_number": "407-792-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PHYSICAL MEDICINE OF LAKE MARY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATIVE PHYSICAL MEDICINE HOLDING LLC",
        "enumeration_date": "2014-03-19",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "OTT",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-792-0705"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Leigh Ippolito

• Specialist in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.