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General NPI Number Information
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NPI Number | 1194122432
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Entity Type | Organization
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Legal Business Name | LET'S GET LACED INC.
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 12743 BISCAYNE BLVD
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2003
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Country | US
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Telephone | 240-442-2261
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Fax | 855-695-1453
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Provider Business Mailing Address
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Address Line | 5418 W ATLANTIC BLVD
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City | MARGATE
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State | FL
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Zip | 33063-5209
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Country | US
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Telephone | 954-960-5950
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Fax | 855-695-1453
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AESHA SUMAYYA NEWMAN
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Credential |
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Telephone | 240-416-4307
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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 |
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License Number State |
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