Organization
THE BRA SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SYLVIA DEANNA JONES B.O.C. (OWNER)
(817) 263-0014
Entity
Organization
Contact information
Practice address
6231 OAKMONT BLVD, FORT WORTH, TX 76132-2812
(817) 263-0014
(817) 263-5779
Mailing address
6231 OAKMONT BLVD, FORT WORTH, TX 76132-2812
(817) 263-0014
(817) 263-5779
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
C17478
TX
Other
Enumeration date
02/09/2008
Last updated
02/09/2008
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