MEDICARE: PATH ACUPUNCTURE, PLLC

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	171100000X	Acupuncturist	AC01683	TX

General Provider Information

NPI Number	:	1063867091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATH ACUPUNCTURE, PLLC

Provider Business Mailing Address
First Line	:	16819 RIBBONRIDGE DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-1927
Country	:	US
Telephone Number	:	281-763-9489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 S MASON RD
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-4563
Country	:	US
Telephone Number	:	281-763-9489
Fax Number	:

Authorized Official
Title or Position	:	OWNER, ACUPUNCTURIST
Name	:	MICHAEL BALL
Credential	:	L.AC.
Telephone Number	:	281-763-9489

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/27/2016

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