Healthcare Provider Details

I. General information

NPI: 1447523303
Provider Name (Legal Business Name): UNIQUELY YOU OF FLORIDA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 60TH STREET CT E SUITE B
BRADENTON FL
34208-6279
US

IV. Provider business mailing address

707 60TH STREET CT E STE B
BRADENTON FL
34208-6268
US

V. Phone/Fax

Practice location:
  • Phone: 941-243-3856
  • Fax: 941-243-3857
Mailing address:
  • Phone: 941-243-3856
  • Fax: 941-243-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. WHITNEY M KITCHENS
Title or Position: VP
Credential:
Phone: 941-705-0046