Provider Demographics
NPI:1730952342
Name:CLASSIC HAIR THERAPY, LLC
Entity type:Organization
Organization Name:CLASSIC HAIR THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-784-3026
Mailing Address - Street 1:5474 WILLIAMS RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9345
Mailing Address - Country:US
Mailing Address - Phone:813-784-3026
Mailing Address - Fax:
Practice Address - Street 1:5474 WILLIAMS RD STE 1B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9345
Practice Address - Country:US
Practice Address - Phone:813-784-3026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies