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General NPI Number Information
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NPI Number | 1588912653
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Entity Type | Organization
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Legal Business Name | WALKWELL WALKING CENTER, LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 220 W JEFFERSON ST
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City | BOISE
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State | ID
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Zip | 83702-6044
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Country | US
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Telephone | 208-343-8907
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Fax |
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Provider Business Mailing Address
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Address Line | 220 W JEFFERSON ST
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City | BOISE
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State | ID
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Zip | 83702-6044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF MANAGING MEMBER
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Name | MR. WILLIAM S STANO
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Credential | D.P.M.
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Telephone | 208-343-8907
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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 |
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License Number State |
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