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General NPI Number Information
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NPI Number | 1659732683
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Entity Type | Organization
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Legal Business Name | REVITALIZE HEALTH ACUPUNCTURE
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 10927 N 56TH ST
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-3000
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Country | US
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Telephone | 760-710-7836
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Fax |
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Provider Business Mailing Address
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Address Line | 503 E JACKSON ST # 224
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City | TAMPA
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State | FL
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Zip | 33602-4904
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Country | US
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Telephone | 760-710-7836
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | DR. LIEM QUANG LE-LAU
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Credential | DAOM
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Telephone | 760-710-7836
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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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