Provider Demographics
NPI:1891109419
Name:BOOTS N BUCKLES
Entity Type:Organization
Organization Name:BOOTS N BUCKLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-210-5819
Mailing Address - Street 1:1671 POOLVILLE CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:POOLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76487-3639
Mailing Address - Country:US
Mailing Address - Phone:800-210-5819
Mailing Address - Fax:
Practice Address - Street 1:1671 POOLVILLE CUT OFF RD
Practice Address - Street 2:
Practice Address - City:POOLVILLE
Practice Address - State:TX
Practice Address - Zip Code:76487-3639
Practice Address - Country:US
Practice Address - Phone:800-210-5819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty