Provider Demographics
NPI:1952787103
Name:SOUTH TEXAS PEDORTHICS,LLC
Entity Type:Organization
Organization Name:SOUTH TEXAS PEDORTHICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSKAR
Authorized Official - Middle Name:LUKAS
Authorized Official - Last Name:OLIVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:361-664-5764
Mailing Address - Street 1:601 E MAIN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4972
Mailing Address - Country:US
Mailing Address - Phone:361-664-5764
Mailing Address - Fax:361-664-5767
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4972
Practice Address - Country:US
Practice Address - Phone:361-664-5764
Practice Address - Fax:361-664-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty