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General NPI Number Information
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NPI Number | 1659670990
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Entity Type | Organization
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Legal Business Name | A PERFECT FIT BOUTIQUE, LLC
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Dates
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Enumeration Date | 03/25/2011
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 1853 BATTLEFIELD PKWY
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City | FT. OGLETHORPE
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State | GA
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Zip | 30742-5166
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Country | US
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Telephone | 706-858-0710
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Fax | 706-858-0810
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Provider Business Mailing Address
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Address Line | 1853 BATTLEFIELD PKWY
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4021
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Country | US
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Telephone | 706-858-0710
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Fax | 706-858-0810
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL KUEBLER
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Credential |
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Telephone | 706-858-0710
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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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