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General NPI Number Information
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NPI Number | 1861735177
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Entity Type | Organization
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Legal Business Name | GENTLE THERAPEUTICS, INC.
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 1707 CONSULATE PL #203
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-1849
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Country | US
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Telephone | 561-703-5930
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Fax | 566-165-6488
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Provider Business Mailing Address
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Address Line | 1707 CONSULATE PL #203
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-1849
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Country | US
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Telephone | 561-703-5930
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Fax | 566-165-6488
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIO M INDIVIGLIO
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Credential | DOM, AP
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Telephone | 561-703-5930
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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 | AP 882
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License Number State | FL
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