Provider Demographics
NPI:1235362096
Name:SOURCE POINT ACUPUNCTURE, PA
Entity Type:Organization
Organization Name:SOURCE POINT ACUPUNCTURE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEL
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:904-859-5333
Mailing Address - Street 1:27 ARBOR CLUB DR UNIT 216
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2605
Mailing Address - Country:US
Mailing Address - Phone:904-859-5333
Mailing Address - Fax:
Practice Address - Street 1:797 MAYPORT RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-3425
Practice Address - Country:US
Practice Address - Phone:904-859-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2548261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service