Provider Demographics
NPI:1154560647
Name:Z-COIL PAIN RELIEF FOOTWEAR
Entity type:Organization
Organization Name:Z-COIL PAIN RELIEF FOOTWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-890-2433
Mailing Address - Street 1:2674 S GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3718
Mailing Address - Country:US
Mailing Address - Phone:417-890-2433
Mailing Address - Fax:417-890-2434
Practice Address - Street 1:2674 S GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3718
Practice Address - Country:US
Practice Address - Phone:417-890-2433
Practice Address - Fax:417-890-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBUS2005-01443335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier