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General NPI Number Information
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NPI Number | 1447861828
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Entity Type | Organization
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Legal Business Name | MAJOR MIRACLES RX
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 1801 E 51ST ST STE 362
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City | AUSTIN
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State | TX
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Zip | 78723-3434
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Country | US
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Telephone | 512-296-8129
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Fax | 737-273-9752
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Provider Business Mailing Address
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Address Line | 292 HOUSEFINCH LOOP
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City | LEANDER
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State | TX
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Zip | 78641-1766
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Country | US
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Telephone | 512-296-8129
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Fax | 737-273-9752
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLE MOORE
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Credential |
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Telephone | 512-296-8129
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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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