MEDICARE: RHODA E PILLSBURY RM/T, LAC

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	171100000X	Acupuncturist	968-55	WI

General Provider Information

NPI Number	:	1316455629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHODA E PILLSBURY RM/T, LAC

Provider Business Mailing Address
First Line	:	3821 SOUTHWOOD DR APT 216
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-5538
Country	:	US
Telephone Number	:	262-221-2756
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 SOUTHWOOD DR APT 216
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-5538
Country	:	US
Telephone Number	:	262-221-2756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2018
Last Update Date	:	01/21/2018

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