Provider Demographics
NPI:1063696870
Name:RIZZUTO'S WIDE SHOES
Entity type:Organization
Organization Name:RIZZUTO'S WIDE SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:RZZUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-483-5140
Mailing Address - Street 1:4407 N DIVISION ST # 106
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1600
Mailing Address - Country:US
Mailing Address - Phone:509-483-5140
Mailing Address - Fax:
Practice Address - Street 1:4407 N DIVISION ST # 106
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1600
Practice Address - Country:US
Practice Address - Phone:509-483-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11221335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier