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General NPI Number Information
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NPI Number | 1073807475
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Entity Type | Organization
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Legal Business Name | RALPH'S SHOES
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 336 WATER ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-6132
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Country | US
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Telephone | 715-834-3248
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Fax | 715-831-7112
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Provider Business Mailing Address
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Address Line | 336 WATER ST
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City | EAU CLAIRE
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State | WI
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Zip | 54703-6132
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Country | US
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Telephone | 715-834-3248
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Fax | 715-831-7112
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Authorized Official
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Title or Position | OWNER
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Name | MR. BOB MC ROBERTS
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Credential | C-PED
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Telephone | 715-834-4568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | C-PED2969
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License Number State |
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