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General NPI Number Information
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NPI Number | 1437459096
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Entity Type | Organization
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Legal Business Name | FEET PLUS OF ARKANSAS, INC
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 163 N MAESTRI RD
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City | SPRINGDALE
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State | AR
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Zip | 72762-9818
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Country | US
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Telephone | 479-361-8004
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 N LITTLE AVE
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City | CUSHING
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State | OK
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Zip | 74023-2033
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Country | US
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Telephone | 918-225-1819
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, BILLING & CREDENTIALING
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Name | KATHY C BOSS
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Credential |
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Telephone | 405-747-6443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | E6411
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License Number State | AR
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