Provider Demographics
NPI:1043603293
Name:ROOT HEALING ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:ROOT HEALING ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:727-437-8582
Mailing Address - Street 1:595 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4903
Mailing Address - Country:US
Mailing Address - Phone:727-437-8582
Mailing Address - Fax:
Practice Address - Street 1:595 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4903
Practice Address - Country:US
Practice Address - Phone:727-437-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3311171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty