Provider Demographics
NPI:1023382116
Name:VISAGE STUDIOS, LLC
Entity Type:Organization
Organization Name:VISAGE STUDIOS, LLC
Other - Org Name:VISAGE CUSTOM PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ANAPLASTOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-732-2658
Mailing Address - Street 1:53 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-1773
Mailing Address - Country:US
Mailing Address - Phone:314-732-2658
Mailing Address - Fax:
Practice Address - Street 1:53 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1773
Practice Address - Country:US
Practice Address - Phone:314-732-2658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Single Specialty