Healthcare Provider Details

I. General information

NPI: 1366529653
Provider Name (Legal Business Name): GENTLE FOOTCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 PORTLAND WAY N
GALION OH
44833-1115
US

IV. Provider business mailing address

PO BOX 27940
COLUMBUS OH
43227-0940
US

V. Phone/Fax

Practice location:
  • Phone: 419-468-3668
  • Fax: 419-462-5037
Mailing address:
  • Phone: 614-239-9444
  • Fax: 614-239-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY S WILSON
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 614-239-9444