Healthcare Provider Details

I. General information

NPI: 1720123607
Provider Name (Legal Business Name): HANSON SHOES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 LEE RD SUITE 117
WINTER PARK FL
32789
US

IV. Provider business mailing address

1950 LEE RD SUITE 117
WINTER PARK FL
32789
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-4111
  • Fax:
Mailing address:
  • Phone: 407-629-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberPED34
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCPED34
License Number StateFL

VIII. Authorized Official

Name: MR. FRANK RUGGIERI
Title or Position: SD
Credential: CPED
Phone: 407-629-4111