Healthcare Provider Details

I. General information

NPI: 1508343328
Provider Name (Legal Business Name): NAPPY ROOTZ 15, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 CORNER SQUARE PLAZA
MONCKS CORNER SC
29461
US

IV. Provider business mailing address

393 CORNER SQUARE PLZ
MONCKS CORNER SC
29461-3211
US

V. Phone/Fax

Practice location:
  • Phone: 843-714-7514
  • Fax:
Mailing address:
  • Phone: 843-714-7514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTINA ALIN SNIDER
Title or Position: 0WNER
Credential:
Phone: 843-714-7514