Healthcare Provider Details

I. General information

NPI: 1255473344
Provider Name (Legal Business Name): HAPPY FEET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 KIHEKAH AVE
PAWHUSKA OK
74056-4225
US

IV. Provider business mailing address

606 KIHEKAH AVE
PAWHUSKA OK
74056-4225
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-1400
  • Fax: 918-287-1814
Mailing address:
  • Phone: 918-287-1400
  • Fax: 918-287-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA FLOWERETTE
Title or Position: OWNER
Credential:
Phone: 918-287-1400