Organization
LIFESHAPES BOUTIQUE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FELICIA NORIEGA DICKEY (OWNER)
(813) 629-6331
Entity
Organization
Contact information
Practice address
518 LAKEWOOD DR, BRANDON, FL 33510-4037
(813) 654-6968
(813) 655-6968
Mailing address
518 LAKEWOOD DR, BRANDON, FL 33510-4037
(813) 654-6968
(813) 655-6968
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M2444
BCBS
FL
Enumeration date
09/22/2006
Last updated
08/22/2020
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