Healthcare Provider Details

I. General information

NPI: 1154643864
Provider Name (Legal Business Name): NATURAL HEALTHCARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 N. ANDREWS AVENUE
WILTON MANORS FL
33311
US

IV. Provider business mailing address

2713 N. ANDREWS AVENUE
WILTON MANORS FL
33311
US

V. Phone/Fax

Practice location:
  • Phone: 954-568-5252
  • Fax: 954-568-6833
Mailing address:
  • Phone: 954-568-5252
  • Fax: 954-568-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1048
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA11470
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA26581
License Number StateFL

VIII. Authorized Official

Name: PETER-JOHN ASTON RHODEN
Title or Position: PRESIDENT
Credential:
Phone: 954-568-5252