Organization
FOOT PAIN RELIEF STORE LLC
Active
Organization
FOOT PAIN RELIEF STORE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA HOLLOWAY (PRESIDENT/OWNER)
(512) 374-0818
Entity
Organization
Contact information
Practice address
12406 TOEPPERWEIN RD, LIVE OAK, TX 78233-3230
(210) 326-8889
Mailing address
12406 TOEPPERWEIN RD, LIVE OAK, TX 78233-3230
(210) 326-8889
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
NOT APPLICABLE
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
531408
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/26/2006
Last updated
05/13/2009
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