Healthcare Provider Details

I. General information

NPI: 1275084600
Provider Name (Legal Business Name): SRQ ACUPUNCTURE & MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SOUTH TUTTLE AVE
SARASOTA FL
34239
US

IV. Provider business mailing address

1810 SOUTH TUTTLE AVE
SARASOTA FL
34239
US

V. Phone/Fax

Practice location:
  • Phone: 941-400-1707
  • Fax:
Mailing address:
  • Phone: 941-400-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2621
License Number StateFL

VIII. Authorized Official

Name: ANGELA HYNES
Title or Position: PHYSICIAN/OWNER
Credential: AP, DOM
Phone: 941-539-5004