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General NPI Number Information
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NPI Number | 1518134089
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEARING SOLUTIONS, INC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 184 S TIFFANY DR SUITE 108
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3583
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Country | US
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Telephone | 719-671-6674
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Fax | 719-647-0262
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Provider Business Mailing Address
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Address Line | 184 S TIFFANY DR SUITE 108
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City | PUEBLO WEST
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State | CO
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Zip | 81007-3583
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Country | US
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Telephone | 719-671-6674
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Fax | 719-647-0262
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Authorized Official
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Title or Position | OWNER/AUDIOLOGIST
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Name | MARY MARTINO
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Credential | AUDIOLOGIST
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Telephone | 719-671-6674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 16
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License Number State | CO
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