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General NPI Number Information
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NPI Number | 1689964199
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Entity Type | Organization
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Legal Business Name | VREELAND ACUPUNCTURE LLC
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 2180 A1A S SUITE 104
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-6591
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Country | US
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Telephone | 904-814-4323
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 840283
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32080-0283
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Country | US
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Telephone | 904-814-4323
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURE PHYSICIAN
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Name | MIMI VREELAND
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Credential | AP
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Telephone | 904-814-4323
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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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