Healthcare Provider Details

I. General information

NPI: 1255598462
Provider Name (Legal Business Name): THERABOOTIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 IRISH RD
WEST FALLS NY
14170-9624
US

IV. Provider business mailing address

7521 IRISH RD
WEST FALLS NY
14170-9624
US

V. Phone/Fax

Practice location:
  • Phone: 716-941-6276
  • Fax: 716-941-6276
Mailing address:
  • Phone: 716-941-6276
  • Fax: 716-941-6276

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: MRS. JEAN ANNE ZICCARELLI
Title or Position: PRESIDENT
Credential:
Phone: 716-941-6276