Healthcare Provider Details

I. General information

NPI: 1447301478
Provider Name (Legal Business Name): THE FOOT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEBRON AVE
GLASTONBURY CT
06033-2176
US

IV. Provider business mailing address

196 PARKWAY S SUITE 304
WATERFORD CT
06385-1234
US

V. Phone/Fax

Practice location:
  • Phone: 860-657-3668
  • Fax: 860-657-1678
Mailing address:
  • Phone: 860-442-7027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J SCANLON
Title or Position: OWNER
Credential: DPM
Phone: 860-456-4250