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General NPI Number Information
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NPI Number | 1013527274
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Entity Type | Organization
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Legal Business Name | LASTING MPRESSIONS SALON AND SPA
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 312 E NINE MILE RD STE 17
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City | PENSACOLA
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State | FL
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Zip | 32514-1475
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Country | US
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Telephone | 850-760-2454
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Fax |
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Provider Business Mailing Address
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Address Line | 312 E NINE MILE RD STE 17
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City | PENSACOLA
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State | FL
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Zip | 32514-1475
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Country | US
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Telephone | 850-760-2454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA L MALONE
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Credential |
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Telephone | 850-619-5664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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