Southlake Foot & Wellness Center LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

AC00108 Issued in TX

Legal business name

SOUTHLAKE FOOT & WELLNESS CENTER LLC

Practice address

6407 Colleyville Blvd Ste B
Colleyville, TX 76034-6279

Phone

(817) 527-6077

Fax

(817) 796-1694

NPI assigned

Mar 15, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vitality Wellness Clinic

Title

Owner

Phone

(817) 527-6077

Specialties & licenses 1

Addresses

Other names 1

• Vitality Wellness Clinic Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696464000000",
    "number": "1154824209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W WALL ST STE 103",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517419",
            "telephone_number": "817-527-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6407 COLLEYVILLE BLVD STE B",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760346279",
            "telephone_number": "817-527-6077",
            "fax_number": "817-796-1694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE FOOT & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A",
        "authorized_official_last_name": "CLINIC",
        "authorized_official_first_name": "VITALITY",
        "authorized_official_middle_name": "WELLNESS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-527-6077"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "AC00108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vitality Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vitality Wellness Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christopher Eric Solomon, PHARMD
• Kristen A Sorensen, APRN
• Angela Elizabeth Soto, OT
• Jonathan Soto, MD
• Steven Robert Souders, PA-C
• Logan Spacek
• Heather Lynn Spengler, PMHNP-BC
• Sreedevi Kodali, M.D., PLLC
• St Agatha Caregivers Inc
• Brigette Stamp, BCBA, LBA

• Specialist in Colleyville, TX
• Providers in Colleyville, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.