=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184334401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOT THERAPIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2022
-----------------------------------------------------
Last Update Date | 12/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4370 S TAMIAMI TRL STE 314
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-777-5055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7798 MOONSTONE DR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-3258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-724-1884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA FRITZ
-----------------------------------------------------
Credential | AP
-----------------------------------------------------
Telephone | 941-777-5505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------