Healthcare Provider Details

I. General information

NPI: 1639210321
Provider Name (Legal Business Name): LOTUS HEART HOLISTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 E NEW HAVEN AVE
MELBOURNE FL
32901-5461
US

IV. Provider business mailing address

529 E NEW HAVEN AVE
MELBOURNE FL
32901-5461
US

V. Phone/Fax

Practice location:
  • Phone: 321-768-7575
  • Fax:
Mailing address:
  • Phone: 321-768-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMM11508
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMM11508
License Number StateFL

VIII. Authorized Official

Name: DELLA RAE DANLEY
Title or Position: OWNER
Credential: LMT
Phone: 321-768-7575