Provider Demographics
NPI:1053578146
Name:WALK RITE FOOTCARE, LLC
Entity type:Organization
Organization Name:WALK RITE FOOTCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PEDORTHICS
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPED/L RN
Authorized Official - Phone:615-772-3820
Mailing Address - Street 1:2021 CHURCH ST
Mailing Address - Street 2:PLAZA II SUITE 408
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2021
Mailing Address - Country:US
Mailing Address - Phone:615-772-3820
Mailing Address - Fax:
Practice Address - Street 1:2021 CHURCH ST
Practice Address - Street 2:PLAZA II SUITE 408
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2021
Practice Address - Country:US
Practice Address - Phone:615-772-3820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-17
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6202740001Medicare NSC