Provider Demographics
NPI:1952881351
Name:PEART, EKATERINA (AP)
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:PEART
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 MARINER WAY
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5420
Mailing Address - Country:US
Mailing Address - Phone:813-465-3555
Mailing Address - Fax:
Practice Address - Street 1:210 N WESTMONTE DR STE 2004
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3357
Practice Address - Country:US
Practice Address - Phone:407-675-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist