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General NPI Number Information
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NPI Number | 1851635031
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Entity Type | Organization
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Legal Business Name | SECOND TO NATURE BOUTIQUE, LLC
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2549 GREENSBORO RD
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City | MARTINSVILLE
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State | VA
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Zip | 24112-0676
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Country | US
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Telephone | 276-670-2727
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Fax | 276-670-2007
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Provider Business Mailing Address
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Address Line | 500 STATE ST UNIT A
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City | GREENSBORO
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State | NC
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Zip | 27405-5659
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Country | US
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Telephone | 336-274-2003
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. RAMONA R. HERTZELL
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Credential | CFM
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Telephone | 336-274-2003
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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 | 10--F001
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License Number State | NC
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