Healthcare Provider Details

I. General information

NPI: 1033483961
Provider Name (Legal Business Name): ACUPUNCTURE MASSAGE HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 ATLANTIC SHORES BLVD STE B
HALLANDALE BEACH FL
33009-2533
US

IV. Provider business mailing address

616 ATLANTIC SHORES BLVD STE B
HALLANDALE BEACH FL
33009-2533
US

V. Phone/Fax

Practice location:
  • Phone: 954-458-4747
  • Fax:
Mailing address:
  • Phone: 954-458-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP957
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA5818
License Number StateFL

VIII. Authorized Official

Name: MS. SHARON ANN SOOTIN
Title or Position: OWNER
Credential: AP LMT
Phone: 954-458-4747