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General NPI Number Information
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NPI Number | 1245522929
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Entity Type | Organization
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Legal Business Name | MEDICINAL LIFE LLC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 5222 ANDRUS AVE SUITE D
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City | ORLANDO
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State | FL
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Zip | 32810-5456
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Country | US
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Telephone | 407-412-6354
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Fax | 407-420-7066
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Provider Business Mailing Address
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Address Line | 5222 ANDRUS AVE SUITE D
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City | ORLANDO
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State | FL
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Zip | 32810-5456
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Country | US
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Telephone | 407-412-6354
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Fax | 407-420-7066
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ROBERT MURPHY
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Credential | AP
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Telephone | 407-412-6354
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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 | AP2879
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License Number State | FL
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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 | AP2967
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA36621
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2755
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License Number State | FL
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