1205944501 NPI number — HOLISTIC THERAPEUTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205944501 NPI number — HOLISTIC THERAPEUTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC THERAPEUTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205944501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
626 SW 127TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32669-5405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-359-5667
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 W NEWBERRY RD
Provider Second Line Business Practice Location Address:
SUITE D-4
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-359-5667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHOENBORN
Authorized Official First Name:
SANDIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST / OWNER
Authorized Official Telephone Number:
352-359-5667

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  PT8189 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y5794 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com