Healthcare Provider Details

I. General information

NPI: 1386019073
Provider Name (Legal Business Name): ISALON PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2015
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 COLUMBUS ST
BEDFORD OH
44146-2819
US

IV. Provider business mailing address

18 COLUMBUS ST
BEDFORD OH
44146-2819
US

V. Phone/Fax

Practice location:
  • Phone: 216-673-8527
  • Fax:
Mailing address:
  • Phone: 216-673-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LATASHA DODSON
Title or Position: HAIR LOSS SPECIALIST
Credential:
Phone: 216-673-8527