Organization
MANIFEST WIGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BREANDA HARRIS RN (CEO)
(832) 800-4392
Entity
Organization
Contact information
Practice address
6464 E SAM HOUSTON PKWY N APT 410, HOUSTON, TX 77049-7269
(832) 800-4392
Mailing address
6022 E SAM HOUSTON PKWY N # 1052, HOUSTON, TX 77049-2511
(832) 800-4392
(832) 218-5555
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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