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General NPI Number Information
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NPI Number | 1265780720
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Entity Type | Organization
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Legal Business Name | PORT ORANGE ACUPUNCTURE LLC
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 100 CESSNA BLVD SUITE B
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City | PORT ORANGE
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State | FL
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Zip | 32128-6969
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Country | US
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Telephone | 386-761-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CESSNA BLVD SUITE B
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City | PORT ORANGE
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State | FL
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Zip | 32128-6969
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Country | US
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Telephone | 386-761-8818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEAGHAN E PHILLIPS
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Credential | A.P.
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Telephone | 386-314-3959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MA38975
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP3008
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License Number State | FL
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