Basic Information
| Provider Information | |||||||||
| NPI: | 1811222508 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHOLE FAMILY HEALTHCARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 LOUISIANA AVE | ||||||||
| Address2: | STE E | ||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327892340 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 LOUISIANA AVE | ||||||||
| Address2: | STE E | ||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327892340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076442990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 10/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | D' ANTONIO | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4076442990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | A.P. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.