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General NPI Number Information
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NPI Number | 1376261255
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Entity Type | Organization
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Legal Business Name | PHENOMENAL TRESSES LLC
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 1010 S MAGNOLIA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32301-4658
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Country | US
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Telephone | 850-332-3434
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Fax | 850-806-1883
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Provider Business Mailing Address
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Address Line | 1010 S MAGNOLIA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32301-4658
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Country | US
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Telephone | 850-332-3434
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Fax | 850-806-1883
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Authorized Official
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Title or Position | PROSTHETIC ORTHOTIC PROVIDER
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Name | MRS. THAMAR WILLIAMS
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Credential |
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Telephone | 850-332-3434
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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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