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General NPI Number Information
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NPI Number | 1508056763
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Entity Type | Organization
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Legal Business Name | BBR SOLE ,INC.
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 1981 N PEBBLE CREEK PKWY C-5
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City | GOODYEAR
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State | AZ
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Zip | 85395-2543
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Country | US
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Telephone | 623-536-6676
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Fax | 623-536-6686
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Provider Business Mailing Address
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Address Line | 1981 N PEBBLE CREEK PKWY C-5
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City | GOODYEAR
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State | AZ
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Zip | 85395-2543
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Country | US
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Telephone | 623-536-6676
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Fax | 623-536-6686
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. LYNELLE RAE REYNOLDS
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Credential |
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Telephone | 623-536-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 20177786
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License Number State | AZ
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