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General NPI Number Information
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NPI Number | 1639524440
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Entity Type | Organization
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Legal Business Name | LIFE IN BALANCE ACUPUNCTURE & WELLNESS
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 4505 W FLAGLER ST SUITE 202
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City | CORAL GABLES
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State | FL
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Zip | 33134-1500
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Country | US
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Telephone | 786-364-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 1642 SW 18TH AVE
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City | MIAMI
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State | FL
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Zip | 33145-1467
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Country | US
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Telephone | 954-290-1974
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURE PHYSICIAN
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Name | TANYA LYNN SYMONETTE
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Credential | D.O.M., A.P.
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Telephone | 954-290-1974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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