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General NPI Number Information
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NPI Number | 1861100638
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Entity Type | Organization
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Legal Business Name | BEAUTY BOUTIQUE HAIR SALON
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 29 S 60TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3004
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Country | US
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Telephone | 215-921-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 29 S 60TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NYDISHA BOYD
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Credential |
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Telephone | 267-253-7053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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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 | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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