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General NPI Number Information
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NPI Number | 1215326954
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Entity Type | Organization
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Legal Business Name | LOTUS ACUPUNCTURE
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 3939 CHEVAL BLVD
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City | LUTZ
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State | FL
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Zip | 33558-5320
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Country | US
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Telephone | 813-949-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 24015 TIMBERSET CT
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City | LUTZ
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State | FL
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Zip | 33559-6729
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Country | US
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Telephone | 813-505-0418
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MISS ASHLEY NICOLE HEINTZ
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Credential | A.P
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Telephone | 813-505-0418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 3485
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License Number State | FL
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