| NPI | 1457926164 |
|---|---|
| Former Legal Business Name | PHATS EXTENSION BAR |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DENISE SHEAD Hair Loss Practtitioner/Owner 903-722-0734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |