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General NPI Number Information
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NPI Number | 1740688431
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Entity Type | Organization
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Legal Business Name | PLANT STREET ACUPUNCTURE INC.
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 314 E PLANT ST # A-101
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City | WINTER GARDEN
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State | FL
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Zip | 34787-3133
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Country | US
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Telephone | 407-614-3783
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Fax |
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Provider Business Mailing Address
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Address Line | 314 E PLANT ST # A-101
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City | WINTER GARDEN
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State | FL
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Zip | 34787-3133
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Country | US
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Telephone | 407-614-3783
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIMBERLY A ODISHOO
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Credential | AP
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Telephone | 407-614-3783
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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 | MA45805
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License Number State | FL
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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 | AP3247
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License Number State | FL
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