Provider Demographics
NPI:1639524440
Name:LIFE IN BALANCE ACUPUNCTURE & WELLNESS
Entity Type:Organization
Organization Name:LIFE IN BALANCE ACUPUNCTURE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SYMONETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:954-290-1974
Mailing Address - Street 1:1642 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1467
Mailing Address - Country:US
Mailing Address - Phone:954-290-1974
Mailing Address - Fax:
Practice Address - Street 1:4505 W FLAGLER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1500
Practice Address - Country:US
Practice Address - Phone:786-364-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty