Provider Demographics
NPI:1972864353
Name:CREATIVE PEDORTHICS, LLC
Entity Type:Organization
Organization Name:CREATIVE PEDORTHICS, LLC
Other - Org Name:ARCHES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARLHEINZ
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHL
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, BOCPED
Authorized Official - Phone:254-773-2693
Mailing Address - Street 1:1616 AZALEA DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2774
Mailing Address - Country:US
Mailing Address - Phone:254-773-2693
Mailing Address - Fax:
Practice Address - Street 1:1616 AZALEA DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2774
Practice Address - Country:US
Practice Address - Phone:254-773-2693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-02
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6716820001OtherMEDICARE PTAN