Provider Demographics
NPI:1225388747
Name:SURVIVOR GALS SPECIALTY PRODUCTS AND SALON LLC
Entity Type:Organization
Organization Name:SURVIVOR GALS SPECIALTY PRODUCTS AND SALON LLC
Other - Org Name:SURVIVOR GALS IRVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-599-7677
Mailing Address - Street 1:3000 CUSTER RD STE 190
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2082
Mailing Address - Country:US
Mailing Address - Phone:972-599-7677
Mailing Address - Fax:972-599-1011
Practice Address - Street 1:2001 N MACARTHUR BLVD STE 130
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2250
Practice Address - Country:US
Practice Address - Phone:972-579-9700
Practice Address - Fax:972-579-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier