Healthcare Provider Details

I. General information

NPI: 1043000813
Provider Name (Legal Business Name): FOOT CARE CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 TRIFECTA PL STE 200
CHARLES TOWN WV
25414-5720
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: KIYA BOYCE
Title or Position: REGIONAL CREDENTIALING SPECIALIST
Credential:
Phone: 301-933-7133