Provider Demographics
NPI:1275084600
Name:SRQ ACUPUNCTURE & MASSAGE
Entity Type:Organization
Organization Name:SRQ ACUPUNCTURE & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:941-539-5004
Mailing Address - Street 1:1810 SOUTH TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-400-1707
Mailing Address - Fax:
Practice Address - Street 1:1810 SOUTH TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-400-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2621171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty