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General NPI Number Information
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NPI Number | 1568714095
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Entity Type | Organization
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Legal Business Name | STONE WELLNESS LLC
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 2620 MANATEE AVE W SUITE C
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City | BRADENTON
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State | FL
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Zip | 34205-4944
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Country | US
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Telephone | 727-804-6795
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 6TH ST W
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City | PALMETTO
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State | FL
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Zip | 34221-4569
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Country | US
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Telephone | 727-804-6795
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURE PHYSICIAN/OWNER
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Name | MRS. SUSAN K STONE
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Credential | DOM, AP
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Telephone | 727-804-6795
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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 | AP3032
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License Number State | FL
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