Provider Demographics
NPI:1659670990
Name:A PERFECT FIT BOUTIQUE, LLC
Entity Type:Organization
Organization Name:A PERFECT FIT BOUTIQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUEBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-858-0710
Mailing Address - Street 1:1853 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4021
Mailing Address - Country:US
Mailing Address - Phone:706-858-0710
Mailing Address - Fax:706-858-0810
Practice Address - Street 1:1853 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FT. OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-5166
Practice Address - Country:US
Practice Address - Phone:706-858-0710
Practice Address - Fax:706-858-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier