Provider Demographics
NPI:1629943832
Name:THE BEAUT'E BAR
Entity type:Organization
Organization Name:THE BEAUT'E BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SALON OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-444-0737
Mailing Address - Street 1:948 W INTERNATIONAL SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3560
Mailing Address - Country:US
Mailing Address - Phone:386-444-0737
Mailing Address - Fax:
Practice Address - Street 1:948 W INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3560
Practice Address - Country:US
Practice Address - Phone:386-444-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier