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General NPI Number Information
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NPI Number | 1639352180
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL ME
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 531 VALLEY VIEW DR
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City | FONTANA
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State | WI
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Zip | 53125-1198
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Country | US
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Telephone | 262-275-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 531 VALLEY VIEW DRIVE
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City | FONTANA
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State | WI
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Zip | 53125
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Country | US
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Telephone | 262-275-5000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DALE A. JOHNSON
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Credential |
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Telephone | 262-723-5555
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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 | 004-0002290200-01
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License Number State | WI
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