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Organization
PHATS EXTENSION BAR & MAKEUP STUDIO LLC
Active
Organization
PHATS EXTENSION BAR & MAKEUP STUDIO LLC
Active
Other names
PHATS EXTENSION BAR
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY DENISE SHEAD HLP (HAIR LOSS PRACTTITIONER/OWNER)
(903) 722-0734
Entity
Organization
Contact information
Practice address
1950 N NORTHWEST LOOP 323, TYLER, TX 75702-1626
(903) 747-8060
(903) 747-8060
Mailing address
1950 N NORTHWEST LOOP 323, TYLER, TX 75702-1626
(903) 747-8060
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
05/25/2021
Last updated
05/25/2021
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