# ROOT & BRANCH LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Root & Branch Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134622392
- **Authorized official:** LAUREN POLM DOM (CEO)
- **Authorized official phone:** (813) 460-5222

## Contact information

- **Practice address:** 3602 MADACA LN, TAMPA, FL 33618
- **Practice address phone:** (813) 992-5421
- **Mailing address:** 12651 N DALE MABRY HWY UNIT 270657, TAMPA, FL 33688-9028

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | AP3903 | FL | Yes |

## Other

- **Enumeration date:** 03/14/2018
- **Last updated:** 07/22/2018