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General NPI Number Information
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NPI Number | 1275096687
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Entity Type | Organization
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Legal Business Name | LIVING GAIA ACUPUNCTURE LLC
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 605 S MAIN AVE
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City | MINNEOLA
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State | FL
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Zip | 34715-9019
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Country | US
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Telephone | 352-223-9280
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Fax |
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Provider Business Mailing Address
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Address Line | 614 E HIGHWAY 50 STE 367
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City | CLERMONT
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State | FL
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Zip | 34711-3164
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Country | US
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Telephone | 352-223-9280
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | KATHLEEN MCGRATH
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Credential | L.AC
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Telephone | 352-223-9280
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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 |
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License Number State |
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