Provider Demographics
NPI:1841032687
Name:FOOTNANNY, INC.
Entity type:Organization
Organization Name:FOOTNANNY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NAIL TECHNICIAN/MASSAGE
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-746-6813
Mailing Address - Street 1:21012 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2679
Mailing Address - Country:US
Mailing Address - Phone:310-746-6813
Mailing Address - Fax:
Practice Address - Street 1:421 N RODEO DR # A4A
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4500
Practice Address - Country:US
Practice Address - Phone:310-746-6813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty