Healthcare Provider Details

I. General information

NPI: 1699013979
Provider Name (Legal Business Name): CYPRESS HEALTING ARTS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 W NORVELL BRYANT HWY
LECANTO FL
34461-9440
US

IV. Provider business mailing address

2639 W NORVELL BRYANT HWY
LECANTO FL
34461-9440
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-5669
  • Fax: 352-745-5795
Mailing address:
  • Phone: 352-746-5669
  • Fax: 352-745-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 1286
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 21942
License Number StateFL

VIII. Authorized Official

Name: DR. JOSEPH E. SAMUELS
Title or Position: DOCTOR OF ORIENTAL MEDICINE/PRESIDE
Credential: D.O.M.
Phone: 352-746-5669