Provider Demographics
NPI:1376144584
Name:FREESTYLE HEALING SRQ LLC
Entity Type:Organization
Organization Name:FREESTYLE HEALING SRQ LLC
Other - Org Name:FREESTYLE HEALING SRQ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYDEE
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:DACM
Authorized Official - Phone:941-363-1056
Mailing Address - Street 1:3205 SOUTHGATE CIR # 8
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5514
Mailing Address - Country:US
Mailing Address - Phone:941-225-1018
Mailing Address - Fax:941-870-6651
Practice Address - Street 1:3205 SOUTHGATE CIR # 8
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5514
Practice Address - Country:US
Practice Address - Phone:941-363-1056
Practice Address - Fax:941-870-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty