Healthcare Provider Details

I. General information

NPI: 1639524440
Provider Name (Legal Business Name): LIFE IN BALANCE ACUPUNCTURE & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 W FLAGLER ST SUITE 202
CORAL GABLES FL
33134-1500
US

IV. Provider business mailing address

1642 SW 18TH AVE
MIAMI FL
33145-1467
US

V. Phone/Fax

Practice location:
  • Phone: 786-364-7660
  • Fax:
Mailing address:
  • Phone: 954-290-1974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: TANYA LYNN SYMONETTE
Title or Position: OWNER/ACUPUNCTURE PHYSICIAN
Credential: D.O.M., A.P.
Phone: 954-290-1974