Provider Demographics
NPI:1689175044
Name:HOLISTIC HEALTH ON THE GO, INC.
Entity Type:Organization
Organization Name:HOLISTIC HEALTH ON THE GO, INC.
Other - Org Name:RACHELLE TETREAULT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF ACUPUNCTURE AND ORIENTAL
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TETREAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, L,AC
Authorized Official - Phone:772-626-6419
Mailing Address - Street 1:451 SE THANKSGIVING AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4733
Mailing Address - Country:US
Mailing Address - Phone:772-626-6419
Mailing Address - Fax:
Practice Address - Street 1:304 NW BETHANY DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3578
Practice Address - Country:US
Practice Address - Phone:772-626-6419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3872171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty