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General NPI Number Information
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NPI Number | 1780203349
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Entity Type | Organization
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Legal Business Name | FLYING TURTLE HEALING ARTS CORP
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 259 ELM ST STE 300B
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City | SOMERVILLE
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State | MA
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Zip | 02144-2950
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Country | US
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Telephone | 617-294-9109
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Fax |
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Provider Business Mailing Address
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Address Line | 259 ELM ST STE 300B
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City | SOMERVILLE
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State | MA
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Zip | 02144-2950
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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 | FANNIE KOA
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Credential | LAC
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Telephone | 617-294-9109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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