=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194590877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRESSES BY TY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2023
-----------------------------------------------------
Last Update Date | 11/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2414 SANDHILL RD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-753-6456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2414 SANDHILL RD
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-753-6456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. HUBERT TYRONE POWERS II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-753-6456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------