Provider Demographics
NPI:1245522929
Name:MEDICINAL LIFE LLC
Entity type:Organization
Organization Name:MEDICINAL LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:407-412-6354
Mailing Address - Street 1:5222 ANDRUS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5456
Mailing Address - Country:US
Mailing Address - Phone:407-412-6354
Mailing Address - Fax:407-420-7066
Practice Address - Street 1:5222 ANDRUS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5456
Practice Address - Country:US
Practice Address - Phone:407-412-6354
Practice Address - Fax:407-420-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2879171100000X
FLAP2967171100000X
FLMA36621225700000X
FLAP2755171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty