Provider Demographics
NPI:1508056763
Name:BBR SOLE ,INC.
Entity Type:Organization
Organization Name:BBR SOLE ,INC.
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNELLE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-536-6676
Mailing Address - Street 1:1981 N PEBBLE CREEK PKWY
Mailing Address - Street 2:C-5
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2543
Mailing Address - Country:US
Mailing Address - Phone:623-536-6676
Mailing Address - Fax:623-536-6686
Practice Address - Street 1:1981 N PEBBLE CREEK PKWY
Practice Address - Street 2:C-5
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2543
Practice Address - Country:US
Practice Address - Phone:623-536-6676
Practice Address - Fax:623-536-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20177786332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6029080001Medicare NSC