Provider Demographics
NPI:1740688431
Name:PLANT STREET ACUPUNCTURE INC.
Entity type:Organization
Organization Name:PLANT STREET ACUPUNCTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ODISHOO
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:407-614-3783
Mailing Address - Street 1:314 E PLANT ST # A-101
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3133
Mailing Address - Country:US
Mailing Address - Phone:407-614-3783
Mailing Address - Fax:
Practice Address - Street 1:314 E PLANT ST # A-101
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3133
Practice Address - Country:US
Practice Address - Phone:407-614-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3247171100000X
FLMA45805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty