=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649312471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC FOOTWEAR INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 EL PASO ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-220-1225
-----------------------------------------------------
Fax | 210-220-1227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 EL PASO ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-220-1225
-----------------------------------------------------
Fax | 210-220-1227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. RITA C FLORES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-220-1225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------