MEDICARE: ACUPUNCTURE & HERBAL THERAPIES

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	MM29770	FL
2	171100000X	Acupuncturist	AP1965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CO946	OTHER	FL	BCBS NUMBER

General Provider Information

NPI Number	:	1942359070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE & HERBAL THERAPIES

Provider Business Mailing Address
First Line	:	2520 CENTRAL AVE.
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33712
Country	:	US
Telephone Number	:	727-551-0857
Fax Number	:	727-202-6896

Provider Business Practice Location Address
First Line	:	2520 CENTRAL AVE.
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33712
Country	:	US
Telephone Number	:	727-551-0857
Fax Number	:	727-202-6896

Authorized Official
Title or Position	:	ACUPUNCTURE PHYSICIAN
Name	:	ROBERT LINDE
Credential	:	A.P.
Telephone Number	:	727-551-0857

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/19/2018

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Directions to “ACUPUNCTURE & HERBAL THERAPIES ” Practice Location

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