Healthcare Provider Details

I. General information

NPI: 1932783974
Provider Name (Legal Business Name): SALON LISA BROWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 EASTERN VALLEY RD STE 112
MC CALLA AL
35111-3457
US

IV. Provider business mailing address

4760 EASTERN VALLEY RD STE 112
MC CALLA AL
35111-3457
US

V. Phone/Fax

Practice location:
  • Phone: 205-477-1477
  • Fax:
Mailing address:
  • Phone: 205-477-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LISA BROWN
Title or Position: OWNER
Credential:
Phone: 205-477-1477