Provider Demographics
NPI:1962802777
Name:THERESA GILMORE, LAC
Entity type:Organization
Organization Name:THERESA GILMORE, LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:305-812-1844
Mailing Address - Street 1:9990 SW 77TH AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-8115
Mailing Address - Country:US
Mailing Address - Phone:305-812-1844
Mailing Address - Fax:305-598-7242
Practice Address - Street 1:9990 SW 77TH AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-8115
Practice Address - Country:US
Practice Address - Phone:305-812-1844
Practice Address - Fax:305-598-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1721171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty