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General NPI Number Information
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NPI Number | 1891464533
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Entity Type | Organization
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Legal Business Name | BOSSED UP UNLIMITED LLC
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 4700 LOYOLA LN STE 106
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City | AUSTIN
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State | TX
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Zip | 78723-3953
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Country | US
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Telephone | 512-900-7895
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Fax |
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Provider Business Mailing Address
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Address Line | 12616 BRAHMIN DR
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City | AUSTIN
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State | TX
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Zip | 78724-4472
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Country | US
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Telephone | 973-953-6247
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Fax |
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Authorized Official
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Title or Position | PROSTHETIC/ORTHOTIC SUPPLIER
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Name | NATALIE D HARDY
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Credential | DME
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Telephone | 973-953-6247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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