Healthcare Provider Details

I. General information

NPI: 1982845160
Provider Name (Legal Business Name): FOOT HEALERS HOLDINGS - ST. LOUIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SALT LICK RD
SAINT PETERS MO
63376-5974
US

IV. Provider business mailing address

PO BOX 28223
SAINT LOUIS MO
63132-0223
US

V. Phone/Fax

Practice location:
  • Phone: 636-279-1900
  • Fax: 636-279-1013
Mailing address:
  • Phone: 314-550-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MURRAY
Title or Position: PRESIDENT
Credential:
Phone: 314-550-3805