Provider Demographics
NPI:1275096687
Name:LIVING GAIA ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:LIVING GAIA ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:352-223-9280
Mailing Address - Street 1:614 E HIGHWAY 50 STE 367
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3164
Mailing Address - Country:US
Mailing Address - Phone:352-223-9280
Mailing Address - Fax:
Practice Address - Street 1:605 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-9019
Practice Address - Country:US
Practice Address - Phone:352-223-9280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty