Healthcare Provider Details

I. General information

NPI: 1609897750
Provider Name (Legal Business Name): WELL HEELED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-4233
US

IV. Provider business mailing address

1972 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-4233
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-0332
  • Fax: 904-819-9645
Mailing address:
  • Phone: 904-819-0332
  • Fax: 904-819-9645

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: MARK G SCHMITT
Title or Position: OWNER
Credential:
Phone: 904-819-0332