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General NPI Number Information
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NPI Number | 1003129503
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Entity Type | Organization
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Legal Business Name | VIRTUOUS WOMAN BODY SCULPTING
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 532 ROUNDTREE CIR
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City | CHESTER
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State | SC
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Zip | 29706-5185
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Country | US
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Telephone | 803-581-1368
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Fax |
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Provider Business Mailing Address
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Address Line | 532 ROUNDTREE CIR
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City | CHESTER
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State | SC
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Zip | 29706-5185
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Country | US
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Telephone | 803-581-1368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. GINNA BANAE STAMPS
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Credential |
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Telephone | 803-493-8874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 007722032
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License Number State | SC
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