Healthcare Provider Details

I. General information

NPI: 1124541420
Provider Name (Legal Business Name): GOODHAIR COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BELCHER RD UNIT 8428
CLEARWATER FL
33758-8300
US

IV. Provider business mailing address

100 S BELCHER RD UNIT 8428
CLEARWATER FL
33758-8300
US

V. Phone/Fax

Practice location:
  • Phone: 727-304-4247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: MELONEY WASHINGTON
Title or Position: CEO
Credential:
Phone: 727-304-4247