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General NPI Number Information
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NPI Number | 1639613185
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Entity Type | Organization
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Legal Business Name | ALYCE & TRE'SURES HAIR GALLERY
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 1308 N 3RD ST
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City | HARRISBURG
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State | PA
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Zip | 17102-1969
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Country | US
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Telephone | 717-231-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 N 3RD ST
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City | HARRISBURG
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State | PA
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Zip | 17102-1969
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Country | US
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Telephone | 717-231-5599
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Fax |
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Authorized Official
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Title or Position | CERTIFIED HAIR LOSS SPECIALIST
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Name | ALYCE WOOTEN
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Credential |
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Telephone | 717-231-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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