Provider Demographics
NPI:1780396291
Name:GIFTED TOUCH LLC MEDICAL WIGS
Entity type:Organization
Organization Name:GIFTED TOUCH LLC MEDICAL WIGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-219-8699
Mailing Address - Street 1:417 S CHESTNUT ST STE 107
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-0830
Mailing Address - Country:US
Mailing Address - Phone:936-219-8699
Mailing Address - Fax:936-278-3364
Practice Address - Street 1:417 S CHESTNUT ST STE 107
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-0830
Practice Address - Country:US
Practice Address - Phone:936-219-8699
Practice Address - Fax:936-278-3364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIFTED TOUCH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier