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General NPI Number Information
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NPI Number | 1265947246
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Entity Type | Organization
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Legal Business Name | THREE WELLS
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 3150 18TH ST # 547
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2074
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Country | US
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Telephone | 415-857-5082
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Fax |
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Provider Business Mailing Address
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Address Line | 1285 PALOU AVE LOWR
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City | SAN FRANCISCO
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State | CA
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Zip | 94124-3332
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | THOMAS PLANT LEIDY
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Credential | L.AC.
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Telephone | 415-857-5082
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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 | 16745
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License Number State | CA
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