Healthcare Provider Details

I. General information

NPI: 1407693989
Provider Name (Legal Business Name): ALL AMERICAN ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 PASEO REYES DR
ST AUGUSTINE FL
32095-8462
US

IV. Provider business mailing address

101 MARKETSIDE AVE STE 404 PMB 327
PONTE VEDRA FL
32081
US

V. Phone/Fax

Practice location:
  • Phone: 904-916-1714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MORGAN READE
Title or Position: PRESIDENT
Credential:
Phone: 904-916-1714