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General NPI Number Information
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NPI Number | 1972473403
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Entity Type | Organization
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Legal Business Name | GLACIER BLUE ACUPUNCTURE
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 7640 N WICKHAM RD STE 121
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City | MELBOURNE
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State | FL
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Zip | 32940-8147
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Country | US
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Telephone | 321-222-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 MAYFLOWER ST
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City | COCOA
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State | FL
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Zip | 32927-3011
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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 | ACUPUNCTURIST
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Name | MS. TRICIA A BERETZ
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Credential | AP
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Telephone | 617-767-1125
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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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