Healthcare Provider Details

I. General information

NPI: 1760843106
Provider Name (Legal Business Name): LIFE FORCE ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2016
Last Update Date: 03/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 51ST ST E
BRADENTON FL
34208-6862
US

IV. Provider business mailing address

3918 51ST ST E
BRADENTON FL
34208-6862
US

V. Phone/Fax

Practice location:
  • Phone: 941-741-8736
  • Fax:
Mailing address:
  • Phone: 941-741-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1301
License Number StateFL

VIII. Authorized Official

Name: MONIKA M. THOMET
Title or Position: MANAGER
Credential:
Phone: 941-741-8736