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General NPI Number Information
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NPI Number | 1912570318
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Entity Type | Organization
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Legal Business Name | TOTAL TRANSFORMATION VIRGIN HAIR
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 2035 28TH ST SE STE D
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-1549
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Country | US
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Telephone | 616-719-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 28TH ST SE STE D
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-1549
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Country | US
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Telephone | 616-719-0401
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Fax |
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Authorized Official
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Title or Position | OWNER/PERRUQUIER
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Name | MR. TIMOTHY L WOODSON
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Credential |
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Telephone | 616-726-0193
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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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