Healthcare Provider Details

I. General information

NPI: 1487543575
Provider Name (Legal Business Name): BODY & SOUL HAIR RESTORATION, SALON AND SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 E COLFAX AVE
DENVER CO
80220-1512
US

IV. Provider business mailing address

3580 HOLLY ST
DENVER CO
80207-1210
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-3339
  • Fax:
Mailing address:
  • Phone: 303-388-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ALICIA YVETTE BRYANT-MAYES
Title or Position: PRESIDENT
Credential:
Phone: 720-252-5199