=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871862169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASIAN THERAPIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2011
-----------------------------------------------------
Last Update Date | 12/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4235 CENTRAL AVE
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-8230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-744-4925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4235 CENTRAL AVE
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-8230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-744-4925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | GALINA V ROOFENER
-----------------------------------------------------
Credential | L. AC.
-----------------------------------------------------
Telephone | 727-744-4925
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | AP 2638
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------