Provider Demographics
NPI:1477589927
Name:FOOT PAIN RELIEF STORE LLC
Entity Type:Organization
Organization Name:FOOT PAIN RELIEF STORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LI-DA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-374-0818
Mailing Address - Street 1:7801 N LAMAR
Mailing Address - Street 2:SUITE C59
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1028
Mailing Address - Country:US
Mailing Address - Phone:512-374-0818
Mailing Address - Fax:512-374-0810
Practice Address - Street 1:7801 N LAMAR
Practice Address - Street 2:SUITE C59
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1028
Practice Address - Country:US
Practice Address - Phone:512-374-0818
Practice Address - Fax:512-374-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
531408OtherBLUE CROSS BLUE SHIELD
=========OtherPHCS
=========001OtherTRICARE
=========OtherHUMANA
5269060001Medicare NSC
=========001OtherTRICARE