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General NPI Number Information
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NPI Number | 1356797203
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Entity Type | Organization
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Legal Business Name | LONGEVITY ACUPUNCTURE
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 2106 BISPHAM RD
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City | SARASOTA
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State | FL
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Zip | 34231-5522
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Country | US
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Telephone | 941-923-9355
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Fax | 866-670-1715
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Provider Business Mailing Address
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Address Line | 2106 BISPHAM RD
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City | SARASOTA
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State | FL
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Zip | 34231-5522
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Country | US
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Telephone | 941-923-9355
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Fax | 866-670-1715
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | CYNTHIA CLARK
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Credential | L.AC.
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Telephone | 941-923-9355
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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 | AP3067
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License Number State | FL
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