Provider Demographics
NPI:1083001804
Name:WEI BEYOND ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:WEI BEYOND ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSISCIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:AP, MSOM, EMT-P
Authorized Official - Phone:352-253-1009
Mailing Address - Street 1:844 S DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4044
Mailing Address - Country:US
Mailing Address - Phone:352-253-1009
Mailing Address - Fax:
Practice Address - Street 1:844 S DUNCAN DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4044
Practice Address - Country:US
Practice Address - Phone:352-253-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty