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General NPI Number Information
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NPI Number | 1750900114
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Entity Type | Organization
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Legal Business Name | EXPERIENCE LEMIEUX
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 900 N 19TH ST UNIT 3247
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1561
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Country | US
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Telephone | 267-997-1096
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Fax | 855-375-7029
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Provider Business Mailing Address
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Address Line | 900 N 19TH ST UNIT 3247
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1561
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Country | US
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Telephone | 267-997-1096
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Fax | 855-375-7029
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Authorized Official
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Title or Position | OWNER
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Name | MS. ASHLEY EDWARDS
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Credential |
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Telephone | 267-997-1096
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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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