Provider Demographics
NPI:1568714095
Name:STONE WELLNESS LLC
Entity Type:Organization
Organization Name:STONE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:727-804-6795
Mailing Address - Street 1:1213 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4569
Mailing Address - Country:US
Mailing Address - Phone:727-804-6795
Mailing Address - Fax:
Practice Address - Street 1:2620 MANATEE AVE W
Practice Address - Street 2:SUITE C
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4944
Practice Address - Country:US
Practice Address - Phone:727-804-6795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty