Healthcare Provider Details

I. General information

NPI: 1952226094
Provider Name (Legal Business Name): FOOT CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S 2ND ST
HAMILTON MT
59840-2517
US

IV. Provider business mailing address

PO BOX 843465
LOS ANGELES CA
90084-3465
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-7298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER REYZELMAN
Title or Position: CMO
Credential:
Phone: 415-292-0638