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General NPI Number Information
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NPI Number | 1891944211
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Entity Type | Organization
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Legal Business Name | ENERGETIC EXPRESSIONS
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 407 LAKE HOWELL RD SUITE #110
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City | MAITLAND
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State | FL
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Zip | 32751-5908
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Country | US
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Telephone | 407-257-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 407 LAKE HOWELL RD SUITE #110
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City | MAITLAND
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State | FL
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Zip | 32751-5908
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Country | US
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Telephone | 407-257-7239
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MISS ALYSON LEE DIEHL
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Credential | LMT
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Telephone | 407-257-7239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MM21115
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License Number State | FL
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