Healthcare Provider Details

I. General information

NPI: 1770975898
Provider Name (Legal Business Name): GENTLE FOOTCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 WEST MAIN STREET
NEWARK OH
43055
US

IV. Provider business mailing address

PO BOX 27940
COLUMBUS OH
43227-0940
US

V. Phone/Fax

Practice location:
  • Phone: 740-344-2984
  • Fax: 740-522-0128
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 State
# 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