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General NPI Number Information
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NPI Number | 1871048744
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Entity Type | Organization
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Legal Business Name | GREAT SPRING ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 455 PENNSYLVANIA AVE SUITE 290
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-3403
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Country | US
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Telephone | 215-559-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 455 PENNSYLVANIA AVE SUITE 290
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-3403
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Country | US
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Telephone | 215-559-4655
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RACHEL RIZZI
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Credential | L.AC.
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Telephone | 215-559-4655
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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 | AK001043
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License Number State | PA
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