Organization
BEAUTY BOUTIQUE HAIR SALON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NYDISHA BOYD (OWNER)
(267) 253-7053
Entity
Organization
Contact information
Practice address
29 S 60TH ST, PHILADELPHIA, PA 19139-3004
(215) 921-2410
Mailing address
29 S 60TH ST, PHILADELPHIA, PA 19139-3004
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
302F00000X
Exclusive Provider Organization
—
—
305R00000X
Preferred Provider Organization
—
—
305S00000X
Point of Service
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
11/10/2022
Last updated
08/17/2023
Update your record
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