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General NPI Number Information
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NPI Number | 1962676387
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Entity Type | Organization
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Legal Business Name | MANATEE INTEGRATED ACUPUNCTURE LLC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 3653 CORTEZ RD W STE 120
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City | BRADENTON
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State | FL
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Zip | 34210-3168
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Country | US
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Telephone | 941-751-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 SOUTHERN PKWY W
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City | BRADENTON
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State | FL
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Zip | 34205-2938
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Country | US
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Telephone | 941-751-8008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CYNTHIA S EVANS
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Credential | RN, AP, DOM
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Telephone | 941-751-8008
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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 | 2468
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License Number State | FL
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