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General NPI Number Information
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NPI Number | 1053321711
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Entity Type | Organization
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Legal Business Name | FOOTSTEPS,LLC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2647 S RIVERVIEW BLVD SUITE 316
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City | GONZALES
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State | LA
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Zip | 70737-5021
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Country | US
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Telephone | 225-756-0034
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Fax | 225-756-0708
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Provider Business Mailing Address
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Address Line | PO BOX 86124
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City | BATON ROUGE
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State | LA
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Zip | 70879-6124
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Country | US
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Telephone | 225-756-0034
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Fax | 225-756-0708
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER FORMANEK
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Credential | DPM
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Telephone | 225-756-0034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PD321R
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License Number State | LA
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