Provider Demographics
NPI:1760997977
Name:SOLE AESTHETIC, LLC
Entity Type:Organization
Organization Name:SOLE AESTHETIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-600-8403
Mailing Address - Street 1:94 DREW ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1526
Mailing Address - Country:US
Mailing Address - Phone:832-600-8403
Mailing Address - Fax:
Practice Address - Street 1:5959 WEST LOOP S STE 130
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2420
Practice Address - Country:US
Practice Address - Phone:832-600-8403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2104213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty