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General NPI Number Information
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NPI Number | 1346555083
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Entity Type | Organization
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Legal Business Name | TOP THIS WIGS, HAIR REPLACEMENT, SALON, MASSAGE
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 7301 BURNET RD SUITE 107
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City | AUSTIN
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State | TX
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Zip | 78757-2250
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Country | US
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Telephone | 512-458-8671
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Fax | 512-458-8199
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Provider Business Mailing Address
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Address Line | 7301 BURNET RD SUITE 107
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City | AUSTIN
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State | TX
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Zip | 78757-2250
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Country | US
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Telephone | 512-458-8671
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Fax | 512-458-8199
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Authorized Official
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Title or Position | OWNER
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Name | MS. SAMANTHA ANN BERNACKY
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Credential |
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Telephone | 512-458-8671
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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 | 729541
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License Number State | TX
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