Healthcare Provider Details

I. General information

NPI: 1033821954
Provider Name (Legal Business Name): HOLISTIC HEALTH ORLANDO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34771-5821
US

IV. Provider business mailing address

1531 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34771-5821
US

V. Phone/Fax

Practice location:
  • Phone: 407-319-7541
  • Fax: 786-326-9478
Mailing address:
  • Phone: 407-319-7541
  • Fax: 407-326-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEREK CHRISTOPHER MURPHY
Title or Position: OWNER
Credential: DO
Phone: 330-904-4623