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General NPI Number Information
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NPI Number | 1669063368
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Entity Type | Organization
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Legal Business Name | MENDING ROOTS NATUROPATHY LLC
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 117 RIVER ST UNIT B
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City | MILFORD
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State | CT
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Zip | 06460-3315
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Country | US
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Telephone | 203-442-6297
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Fax | 833-520-5011
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Provider Business Mailing Address
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Address Line | 2 RIMMONDALE ST FL 2
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City | SEYMOUR
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State | CT
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Zip | 06483-2931
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE WOOMER
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Credential | ND, L.AC
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Telephone | 203-442-6297
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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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Taxonomy #2
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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