Healthcare Provider Details

I. General information

NPI: 1184209553
Provider Name (Legal Business Name): TINY FEET & HEART BEATS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 N JACKSON ST # B1206
MILWAUKEE WI
53202-3258
US

IV. Provider business mailing address

PO BOX 511676
MILWAUKEE WI
53203-0281
US

V. Phone/Fax

Practice location:
  • Phone: 414-235-7556
  • Fax:
Mailing address:
  • Phone: 414-235-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOYA RENEE TORRENCE
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 414-629-9781