Healthcare Provider Details

I. General information

NPI: 1801822937
Provider Name (Legal Business Name): THE SHOE TREE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DOLLIVER ST
PISMO BEACH CA
93449-2503
US

IV. Provider business mailing address

801 DOLLIVER ST
PISMO BEACH CA
93449-2503
US

V. Phone/Fax

Practice location:
  • Phone: 805-773-5571
  • Fax: 805-773-1270
Mailing address:
  • Phone: 805-773-5571
  • Fax: 805-773-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BOYLD TAYLOR
Title or Position: OWNR/PRESIDENT
Credential:
Phone: 805-773-5571