Provider Demographics
NPI:1174028229
Name:LYLA TERRY SALON
Entity Type:Organization
Organization Name:LYLA TERRY SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SCHQUANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-487-8468
Mailing Address - Street 1:12559 FALLOHIDE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3457
Mailing Address - Country:US
Mailing Address - Phone:904-487-8468
Mailing Address - Fax:
Practice Address - Street 1:12559 FALLOHIDE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3457
Practice Address - Country:US
Practice Address - Phone:904-487-8468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty