MEDICARE: LIVING GAIA ACUPUNCTURE LLC

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

General Provider Information

NPI Number	:	1275096687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING GAIA ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	614 E HIGHWAY 50 STE 367
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-3164
Country	:	US
Telephone Number	:	352-223-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 S MAIN AVE
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-9019
Country	:	US
Telephone Number	:	352-223-9280
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	KATHLEEN MCGRATH
Credential	:	L.AC
Telephone Number	:	352-223-9280

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	04/11/2019

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Directions to “LIVING GAIA ACUPUNCTURE LLC ” Practice Location

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