Healthcare Provider Details

I. General information

NPI: 1689334047
Provider Name (Legal Business Name): ALFIE HARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 09/04/2023
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 BROWN ST # 106
PETERSBURG VA
23803-4234
US

IV. Provider business mailing address

PO BOX 8442
JACKSONVILLE FL
32239-0442
US

V. Phone/Fax

Practice location:
  • Phone: 434-594-8755
  • Fax:
Mailing address:
  • Phone: 434-594-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: