MEDICARE: POSITIVE HAIR RESTORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1073141354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE HAIR RESTORATION

Provider Business Mailing Address
First Line	:	100 INDEPENDENCE PL STE 309
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-1328
Country	:	US
Telephone Number	:	903-561-9697
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 INDEPENDENCE PL STE 309
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-1328
Country	:	US
Telephone Number	:	903-561-9697
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRYSTINA GARCIA
Credential	:
Telephone Number	:	903-561-9697

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	03/31/2020

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Directions to “POSITIVE HAIR RESTORATION ” Practice Location

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