Provider Demographics
NPI:1043730096
Name:INCREDIBLE TECHNOLOGY INC. DBA LASER HEALING THERAPY
Entity Type:Organization
Organization Name:INCREDIBLE TECHNOLOGY INC. DBA LASER HEALING THERAPY
Other - Org Name:LASER HEALING THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:LASER THERAPIST
Authorized Official - Phone:910-769-1356
Mailing Address - Street 1:1602 HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7716
Mailing Address - Country:US
Mailing Address - Phone:910-769-1356
Mailing Address - Fax:
Practice Address - Street 1:1602 HARBOUR DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7716
Practice Address - Country:US
Practice Address - Phone:910-769-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty