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General NPI Number Information
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NPI Number | 1306070354
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Entity Type | Organization
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Legal Business Name | SHEAR EXPRESSIONS
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 490 E HATHAWAY AVE
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City | BRONSON
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State | FL
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Zip | 32621-6736
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Country | US
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Telephone | 352-486-6899
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Fax | 352-486-3865
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | BRONSON
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State | FL
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Zip | 32621-0247
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Country | US
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Telephone | 352-486-6899
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Fax | 352-486-3865
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Authorized Official
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Title or Position | OWNER
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Name | MS. THERESA ALICE ADAMS
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Credential |
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Telephone | 352-486-6899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MM20690
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License Number State | FL
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