Provider Demographics
NPI:1972738375
Name:REX ANNE NUTT
Entity type:Organization
Organization Name:REX ANNE NUTT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:REX
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-962-4168
Mailing Address - Street 1:1099 ROY RD
Mailing Address - Street 2:PO BOX 104
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-6551
Mailing Address - Country:US
Mailing Address - Phone:972-962-4168
Mailing Address - Fax:
Practice Address - Street 1:100 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-3655
Practice Address - Country:US
Practice Address - Phone:972-962-4168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier