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General NPI Number Information
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NPI Number | 1669732301
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Entity Type | Organization
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Legal Business Name | MULBERRY WELLNESS SALON LLC
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Dates
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Enumeration Date | 05/28/2012
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 1734 MULBERRY ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1524
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Country | US
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Telephone | 334-819-7249
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Fax | 334-819-7249
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Provider Business Mailing Address
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Address Line | 1734 MULBERRY ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1524
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Country | US
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Telephone | 334-819-7249
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Fax | 334-819-7249
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Authorized Official
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Title or Position | MASTER COSMETOLOGIST/OWNER
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Name | MS. RAMONA J WASHINGTON
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Credential | CERTIFIED HAIR LOSS
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Telephone | 334-868-5189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 161733
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 161733
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 39089
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 39089
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License Number State | AL
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