Healthcare Provider Details

I. General information

NPI: 1205874914
Provider Name (Legal Business Name): THERAPEUTIC SHOES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 BEULAHS LANE
IDAHO FALLS ID
83401
US

IV. Provider business mailing address

718 BEULAHS LANE
IDAHO FALLS ID
83401
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-1995
  • Fax: 208-524-1995
Mailing address:
  • Phone: 208-524-1995
  • Fax: 208-524-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP085
License Number StateID

VIII. Authorized Official

Name: DR. CHARLES CALL III
Title or Position: PRESIDENT
Credential: DPM
Phone: 208-524-1995