Healthcare Provider Details

I. General information

NPI: 1346718699
Provider Name (Legal Business Name): TRESS RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 SOUTHMOOR ST STE 1209
HANOVER MD
21076-2130
US

IV. Provider business mailing address

7010 SOUTHMOOR ST STE 1209
HANOVER MD
21076-2130
US

V. Phone/Fax

Practice location:
  • Phone: 443-820-5751
  • Fax:
Mailing address:
  • Phone: 443-820-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIM BOWDEN
Title or Position: OWNER
Credential:
Phone: 443-820-5751