MEDICARE: GOULDS BEAUTY SALONS INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1437862661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOULDS BEAUTY SALONS INCORPORATED

Provider Business Mailing Address
First Line	:	766 S WHITE STATION RD STE 3
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-4579
Country	:	US
Telephone Number	:	901-842-1444
Fax Number	:

Provider Business Practice Location Address
First Line	:	3670 S HOUSTON LEVEE RD
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-9142
Country	:	US
Telephone Number	:	901-842-1444
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	PHILIP GOULD
Credential	:
Telephone Number	:	901-842-1444

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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