MEDICARE: ACUPUNCTURE MASSAGE HEALING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA5818	FL
2	171100000X	Acupuncturist	AP957	FL

General Provider Information

NPI Number	:	1033483961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE MASSAGE HEALING CENTER

Provider Business Mailing Address
First Line	:	616 ATLANTIC SHORES BLVD STE B
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2533
Country	:	US
Telephone Number	:	954-458-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 ATLANTIC SHORES BLVD STE B
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2533
Country	:	US
Telephone Number	:	954-458-4747
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHARON ANN SOOTIN
Credential	:	AP LMT
Telephone Number	:	954-458-4747

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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