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General NPI Number Information
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NPI Number | 1659507325
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Entity Type | Organization
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Legal Business Name | DIABETIC FOOTWEAR & SUPPLIES INCORPORATED
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 2912 KRAFT ST SUITE #10
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City | ARLINGTON
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State | TX
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Zip | 76010-5410
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Country | US
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Telephone | 817-261-1177
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Fax | 817-984-3390
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Provider Business Mailing Address
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Address Line | 610 CROWNPOINT LN
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City | ARLINGTON
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State | TX
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Zip | 76002-4776
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Country | US
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Telephone | 817-261-1177
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LONNETTE ALEXANDER
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Credential |
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Telephone | 817-261-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 1000138
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License Number State | TX
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