Organization
REALITY FOOT CARE LLC
Active
Other names
HEALTHY FEET STORE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA ANN BLACK C PED (OWNER)
(817) 377-3668
Entity
Organization
Contact information
Practice address
2921 LACKLAND RD, SUITE 101, FORT WORTH, TX 76116-4173
(817) 377-3668
(817) 377-2646
Mailing address
2921 LACKLAND RD, SUITE 101, FORT WORTH, TX 76116-4173
(817) 377-3668
(817) 377-2646
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
CPED1950
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010258401
—
TX
Enumeration date
05/08/2008
Last updated
11/15/2011
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