Healthcare Provider Details

I. General information

NPI: 1124042809
Provider Name (Legal Business Name): FOOTCARE & MORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/15/2007
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 TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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