Provider Demographics
NPI:1669486577
Name:PAIN AWAY FOOTWEAR LLC
Entity Type:Organization
Organization Name:PAIN AWAY FOOTWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-629-9300
Mailing Address - Street 1:651 N BUSINESS IH 35
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7873
Mailing Address - Country:US
Mailing Address - Phone:830-629-9300
Mailing Address - Fax:830-629-9303
Practice Address - Street 1:651 N BUSINESS IH 35
Practice Address - Street 2:SUITE 250
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7873
Practice Address - Country:US
Practice Address - Phone:830-629-9300
Practice Address - Fax:830-629-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER
TX=========OtherTAX ID NUMBER