Healthcare Provider Details

I. General information

NPI: 1285882605
Provider Name (Legal Business Name): NATURAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 WILMA ST
LONGWOOD FL
32750-4114
US

IV. Provider business mailing address

6770 FORSYTH OAK CT
ORLANDO FL
32807-5081
US

V. Phone/Fax

Practice location:
  • Phone: 407-864-1534
  • Fax:
Mailing address:
  • Phone: 407-864-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberAP2475
License Number StateFL

VIII. Authorized Official

Name: SVETLANA KOTSENKO
Title or Position: ACUPUNCTURE PHYSICIAN
Credential: A.P.
Phone: 407-864-1534