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General NPI Number Information
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NPI Number | 1558132530
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Entity Type | Organization
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Legal Business Name | PRACTICAL PODIATRY LLC
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 508 CARDINAL RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-8535
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Country | US
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Telephone | 918-931-1425
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Fax |
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Provider Business Mailing Address
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Address Line | 508 CARDINAL RD
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City | MUSKOGEE
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State | OK
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Zip | 74403-8535
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Country | US
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Telephone | 918-931-1425
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JULIET COLYER
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Credential | DPM
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Telephone | 918-931-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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