Organization
INNOVATIVE PHYSIATRY SPINE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SECK LIM (PRACTICE ADMINISTRATOR)
(904) 671-0288
Entity
Organization
Contact information
Practice address
165 DURBIN STATION CT STE 601, ST JOHNS, FL 32259-9370
(904) 671-0288
(904) 508-0674
Mailing address
PO BOX 385, PONTE VEDRA BEACH, FL 32004-0385
(904) 671-0288
(904) 508-0674
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
OS12124
FL
Other
Enumeration date
07/06/2017
Last updated
09/02/2021
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