JODY FORMAN, MSW, L.AC., PLLC (CHARLOTTESVILLE HEALING ARTS) - NPI NUMBER 1316243314

Summary

Provider Name: JODY FORMAN, MSW, L.AC., PLLC (CHARLOTTESVILLE HEALING ARTS)

NPI Number: 1316243314

Clasification: Acupuncturist (171100000X)

Address:
355 WEST RIO RD
SUITE 206A
CHARLOTTESVILLE, VA
ZIP 22901

Phone Number: (434) 975-0025



Detailed Information

JODY FORMAN, MSW, L.AC., PLLC is an acupuncturist in Charlottesville, VA. The provider is an acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia. The assigned NPI number for this provider is 1316243314 and is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Charlottesville Healing Arts.

The provider's business address is:

355 WEST RIO RD
SUITE 206A
CHARLOTTESVILLE, VA
ZIP 22901-362
Phone: (434) 975-0025

The provider's authorized official is Jody Forman .
The authorized official title is Licensed Acupuncturist and has the following contact phone number (434) 975-0025.

The enumeration date for this NPI number is 2/8/2011 and was last updated on 2/8/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 171100000X Acupuncturist 0121000011 VA Yes

NPI Record

No. Field Name Field Value
1 NPI 1316243314
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name JODY FORMAN, MSW, L.AC., PLLC
5 Provider Other Organization Name CHARLOTTESVILLE HEALING ARTS
6 Provider Other Organization Name Type Code 5
7 Provider First Line Business Practice Location Address 355 WEST RIO RD
8 Provider Second Line Business Practice Location Address SUITE 206A
9 Provider Business Practice Location Address City Name CHARLOTTESVILLE
10 Provider Business Practice Location Address State Name VA
11 Provider Business Practice Location Address Postal Code 229011362
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 4349750025
14 Provider Enumeration Date 2/8/2011
15 Last Update Date 2/8/2011
16 Authorized Official Last Name FORMAN
17 Authorized Official First Name JODY
18 Authorized Official Title or Position LICENSED ACUPUNCTURIST
19 Authorized Official Telephone Number 4349750025
20 Healthcare Provider Taxonomy Code 1 171100000X
21 Provider License Number 1 0121000011
22 Provider License Number State Code 1 VA
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Is Organization Subpart N
25 Authorized Official Name Prefix Text MS.
26 Authorized Official Credential Text MSW.,L.AC., PLLC
27 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 8/12/2014
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