Healthcare Provider Details

I. General information

NPI: 1891839544
Provider Name (Legal Business Name): QI BY THE SEA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13357 OVERSEAS HWY
MARATHON FL
33050-3550
US

IV. Provider business mailing address

PO BOX 420405
SUMMERLAND KEY FL
33042-0405
US

V. Phone/Fax

Practice location:
  • Phone: 305-797-8527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAP 751
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAP 751
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberAP 751
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberAP 751
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberAP 751
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberAP 751
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberAP 751
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAP 751
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberAP 751
License Number StateFL
# 10
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 751
License Number StateFL

VIII. Authorized Official

Name: DR. JEAN A GORMLEY
Title or Position: PRESIDENT
Credential: D.O.M., A.P., D.C.
Phone: 305-797-8527