Healthcare Provider Details

I. General information

NPI: 1740688431
Provider Name (Legal Business Name): PLANT STREET ACUPUNCTURE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E PLANT ST # A-101
WINTER GARDEN FL
34787-3133
US

IV. Provider business mailing address

314 E PLANT ST # A-101
WINTER GARDEN FL
34787-3133
US

V. Phone/Fax

Practice location:
  • Phone: 407-614-3783
  • Fax:
Mailing address:
  • Phone: 407-614-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3247
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA45805
License Number StateFL

VIII. Authorized Official

Name: KIMBERLY A ODISHOO
Title or Position: PRESIDENT
Credential: AP
Phone: 407-614-3783