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General NPI Number Information
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NPI Number | 1164682233
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Entity Type | Organization
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Legal Business Name | RAPIDS FOOT CARE CENTER LLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 311 8TH ST SO
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-4622
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Country | US
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Telephone | 715-423-8637
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Fax | 715-424-2724
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Provider Business Mailing Address
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Address Line | 311 8TH ST SO
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-4622
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Country | US
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Telephone | 715-423-8637
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Fax | 715-424-2724
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRIC J HARDIMAN
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Credential | DPM
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Telephone | 715-423-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 678-025
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License Number State | WI
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