Organization
PHYLLIS DAVIS COSMETOLOGIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS TERRI DAVIS (COSMETOLOGIST)
(317) 728-0045
Entity
Organization
Contact information
Practice address
2336 E 53RD ST, INDIANAPOLIS, IN 46220-3430
(317) 259-2957
Mailing address
6057 TWYCKENHAM DR, INDIANAPOLIS, IN 46236-7372
(317) 728-0045
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
BC107209275
IN
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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