Healthcare Provider Details

I. General information

NPI: 1679821706
Provider Name (Legal Business Name): HESTER'S SPECIALTY SHOES AND ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STINSON WAY SUITE 102
WEST PALM BEACH FL
33411-3733
US

IV. Provider business mailing address

1000 STINSON WAY SUITE 102
WEST PALM BEACH FL
33411-3733
US

V. Phone/Fax

Practice location:
  • Phone: 561-805-9500
  • Fax: 561-805-9807
Mailing address:
  • Phone: 561-805-9500
  • Fax: 561-805-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PEGGY JEAN LANIER-HESTER
Title or Position: PRESIDENT
Credential: C-PED, R.N.
Phone: 561-805-9500