Provider Demographics
NPI:1366181109
Name:AQUA TERRA HEALTH
Entity type:Organization
Organization Name:AQUA TERRA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TORF-FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:805-258-2684
Mailing Address - Street 1:61196 LODGEPOLE DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2880
Mailing Address - Country:US
Mailing Address - Phone:541-480-8496
Mailing Address - Fax:541-480-4079
Practice Address - Street 1:19820 VILLAGE OFFICE CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2947
Practice Address - Country:US
Practice Address - Phone:541-480-8496
Practice Address - Fax:541-228-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty