Provider Demographics
NPI:1073975553
Name:FOUR SEASONS ACUPOUNCTURE TREATNMENTS
Entity Type:Organization
Organization Name:FOUR SEASONS ACUPOUNCTURE TREATNMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIPLOMAT OF ORIENTLA MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:321-662-4871
Mailing Address - Street 1:185 N LAKEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3203
Mailing Address - Country:US
Mailing Address - Phone:321-662-4871
Mailing Address - Fax:
Practice Address - Street 1:185 N LAKEMONT AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3203
Practice Address - Country:US
Practice Address - Phone:321-662-4871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2715171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1184856726OtherNPI