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General NPI Number Information
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NPI Number | 1497579569
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Entity Type | Organization
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Legal Business Name | CUSTOM CREATIONS, LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 5701 PRESIDENT GEORGE BUSH HWY STE 104
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City | ROWLETT
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State | TX
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Zip | 75089-3691
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Country | US
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Telephone | 469-897-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 3090 N GOLIAD ST STE 102-817
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City | ROCKWALL
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State | TX
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Zip | 75087-7007
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Country | US
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Telephone | 469-897-5040
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYNN GRANT
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Credential |
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Telephone | 469-897-5040
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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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