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General NPI Number Information
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NPI Number | 1770393886
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Entity Type | Organization
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Legal Business Name | THE FOOT BULLY LLC
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 11503 N SAM HOUSTON PKWY E STE H
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City | HUMBLE
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State | TX
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Zip | 77396-4732
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Country | US
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Telephone | 832-875-1540
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Fax |
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Provider Business Mailing Address
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Address Line | 13531 WILL CLAYTON PKWY STE 300 PMB 1128
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City | HUMBLE
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State | TX
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Zip | 77346
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Country | US
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Telephone | 346-355-1550
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Fax | 346-331-4620
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Authorized Official
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Title or Position | CEO
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Name | KRYSTLE CAVINESS
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Credential |
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Telephone | 346-355-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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