Organization
HAIR LOSS SPEALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA L FREEMAN (OWNER)
(407) 761-6238
Entity
Organization
Contact information
Practice address
1631 N COCOA BLVD, COCOA, FL 32922-6935
(321) 632-8855
Mailing address
1631 N. COCOA BLVD., COCOA, FL 32922
(321) 632-8855
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
BB29026
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1744P3200X
PROSTHEICS CASE MANGER
FL
Enumeration date
05/04/2016
Last updated
05/04/2016
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