Healthcare Provider Details

I. General information

NPI: 1972738375
Provider Name (Legal Business Name): REX ANNE NUTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CROSSROADS DR
KAUFMAN TX
75142-3655
US

IV. Provider business mailing address

1099 ROY RD PO BOX 104
KAUFMAN TX
75142-6551
US

V. Phone/Fax

Practice location:
  • Phone: 972-962-4168
  • Fax:
Mailing address:
  • Phone: 972-962-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. REX ANNE NUTT
Title or Position: OWNER/OPERATIONS
Credential:
Phone: 972-962-4168