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General NPI Number Information
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NPI Number | 1023047107
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Entity Type | Organization
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Legal Business Name | MILLENNIUM MEDICAL INC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 5088 66TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33709-3120
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Country | US
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Telephone | 727-541-2675
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Fax | 727-541-3956
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Provider Business Mailing Address
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Address Line | 5088 66TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33709-3120
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Country | US
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Telephone | 727-541-2675
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Fax | 727-541-3956
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Authorized Official
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Title or Position | PRACTICE ADMINSTRATOR
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Name | LYNN S SHULMAN
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Credential |
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Telephone | 727-541-2675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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