Provider Demographics
NPI:1306607197
Name:HAIR-APYBYPERMELIA
Entity type:Organization
Organization Name:HAIR-APYBYPERMELIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:PERMELIA
Authorized Official - Middle Name:CATINA
Authorized Official - Last Name:THOMAS JESSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-875-6225
Mailing Address - Street 1:301 N MAIN ST STE 115
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-4509
Mailing Address - Country:US
Mailing Address - Phone:770-875-6225
Mailing Address - Fax:
Practice Address - Street 1:301 N MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4509
Practice Address - Country:US
Practice Address - Phone:770-875-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier