Provider Demographics
NPI:1952602179
Name:HAPPY FEET THERAPEUTIC, LLC
Entity Type:Organization
Organization Name:HAPPY FEET THERAPEUTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEOS GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:CFTS
Authorized Official - Phone:972-262-0533
Mailing Address - Street 1:605 E. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050
Mailing Address - Country:US
Mailing Address - Phone:972-262-0533
Mailing Address - Fax:877-362-9841
Practice Address - Street 1:605 E. MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:972-262-0533
Practice Address - Fax:877-362-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287982702Medicaid
TX6573480001Medicare NSC