Provider Demographics
NPI:1235452459
Name:PROFESSIONAL HEALING SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMT
Authorized Official - Phone:863-937-8814
Mailing Address - Street 1:5130 S FLORIDA AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2537
Mailing Address - Country:US
Mailing Address - Phone:863-937-8814
Mailing Address - Fax:863-937-8815
Practice Address - Street 1:5130 S FLORIDA AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2537
Practice Address - Country:US
Practice Address - Phone:863-937-8814
Practice Address - Fax:863-937-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7925261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center