Provider Demographics
NPI:1003129503
Name:VIRTUOUS WOMAN BODY SCULPTING
Entity Type:Organization
Organization Name:VIRTUOUS WOMAN BODY SCULPTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINNA
Authorized Official - Middle Name:BANAE
Authorized Official - Last Name:STAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-493-8874
Mailing Address - Street 1:532 ROUNDTREE CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-5185
Mailing Address - Country:US
Mailing Address - Phone:803-581-1368
Mailing Address - Fax:
Practice Address - Street 1:532 ROUNDTREE CIR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-5185
Practice Address - Country:US
Practice Address - Phone:803-581-1368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007722032335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier