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General NPI Number Information
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NPI Number | 1942851704
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Entity Type | Organization
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Legal Business Name | SACRED PATH WELLNESS
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 1515 DALE MABRY HWY STE 102
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City | LUTZ
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State | FL
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Zip | 33548-3023
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Country | US
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Telephone | 813-245-5649
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Fax |
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Provider Business Mailing Address
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Address Line | 18106 PEREGRINES PERCH PL UNIT 111
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City | LUTZ
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State | FL
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Zip | 33558-2785
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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 | PRESIDENT/OWNER
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Name | MS. LEAH LUBIN
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Credential | LAC
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Telephone | 813-245-5649
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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 |
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License Number State |
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