Provider Demographics
NPI:1942531702
Name:SIMPLY FEET LLC
Entity Type:Organization
Organization Name:SIMPLY FEET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR, MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:520-399-1365
Mailing Address - Street 1:75 W CALLE DE LAS TIENDAS
Mailing Address - Street 2:SUITE 133B
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4235
Mailing Address - Country:US
Mailing Address - Phone:520-366-1365
Mailing Address - Fax:520-399-1387
Practice Address - Street 1:75 W CALLE DE LAS TIENDAS
Practice Address - Street 2:SUITE 133B
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4235
Practice Address - Country:US
Practice Address - Phone:520-366-1365
Practice Address - Fax:520-399-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty