Healthcare Provider Details

I. General information

NPI: 1245021682
Provider Name (Legal Business Name): FLAWLESSBYTONI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 W GREENFIELD AVE
WEST ALLIS WI
53214-5047
US

IV. Provider business mailing address

2209 N DR MARTIN LUTHER KING JR DR STE 203
MILWAUKEE WI
53212-3188
US

V. Phone/Fax

Practice location:
  • Phone: 602-791-0397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANTONYA BOATMAN
Title or Position: OWNER
Credential:
Phone: 602-791-0397