Provider Demographics
NPI:1558132530
Name:PRACTICAL PODIATRY LLC
Entity Type:Organization
Organization Name:PRACTICAL PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:COLYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-931-1425
Mailing Address - Street 1:508 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-8535
Mailing Address - Country:US
Mailing Address - Phone:918-931-1425
Mailing Address - Fax:
Practice Address - Street 1:508 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-8535
Practice Address - Country:US
Practice Address - Phone:918-931-1425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty