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General NPI Number Information
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NPI Number | 1740727395
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Entity Type | Organization
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Legal Business Name | THE PERMANENT COSMETIC PLACE
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 791 W 4400 S
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City | RIVERDALE
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State | UT
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Zip | 84405-3443
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Country | US
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Telephone | 801-940-1285
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Fax |
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Provider Business Mailing Address
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Address Line | 791 W 4400 S
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City | RIVERDALE
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State | UT
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Zip | 84405-3443
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Country | US
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Telephone | 801-940-1285
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUDY ROSKELLEY
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Credential | CPCT
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Telephone | 801-940-1285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number |
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License Number State |
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