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General NPI Number Information
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NPI Number | 1811435019
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Entity Type | Organization
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Legal Business Name | HEAVENLY TRESSES LLC
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 855-487-3773
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Fax | 855-269-2733
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 855-487-3773
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Fax | 855-269-2733
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA RENNER-THOMAS
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Credential | HAIR LOSS SPECIALIST
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Telephone | 855-487-3773
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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