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General NPI Number Information
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NPI Number | 1174020549
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Entity Type | Organization
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Legal Business Name | MAKE YOURSELF, LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 128 W 5TH ST
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City | PERU
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State | IN
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Zip | 46970-2139
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Country | US
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Telephone | 765-244-7440
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Fax |
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Provider Business Mailing Address
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Address Line | 128 W 5TH ST
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City | PERU
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State | IN
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Zip | 46970-2139
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Country | US
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Telephone | 765-244-7440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRADLEY R HAMMERSLEY
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Credential | DPM
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Telephone | 765-244-7440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 07000906A
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License Number State | IN
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