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General NPI Number Information
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NPI Number | 1356627939
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Entity Type | Organization
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Legal Business Name | MANE & TAILL THERAPEUTIC HORSEMANSHIP ACADEMY
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 147 COLONIAL BEACH RD
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City | JARVISBURG
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State | NC
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Zip | 27947-9704
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Country | US
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Telephone | 252-489-1774
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Fax |
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Provider Business Mailing Address
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Address Line | 147 COLONIAL BEACH RD
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City | JARVISBURG
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State | NC
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Zip | 27947
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Country | US
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Telephone | 252-489-1774
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PATH INSTRUCTOR
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Name | MISS SAMANTHA KAREN IULO
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Credential |
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Telephone | 252-489-1774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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