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General NPI Number Information
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NPI Number | 1619328192
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Entity Type | Organization
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Legal Business Name | FIVE PETAL HOLISTIC HEALING CENTER
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 830 CENTRAL AVE
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City | SARASOTA
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State | FL
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Zip | 34236-4021
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Country | US
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Telephone | 941-315-6858
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Fax |
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Provider Business Mailing Address
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Address Line | 1853 5TH ST
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City | SARASOTA
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State | FL
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Zip | 34236-4208
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Country | US
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Telephone | 941-315-6858
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANGELA RUTH RAUTER
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Credential | A.P., D.O.M.,
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Telephone | 941-315-6858
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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 | FL
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