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General NPI Number Information
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NPI Number | 1124101373
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Entity Type | Organization
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Legal Business Name | FOOTHEALS PROSTHETICS AND ORTHOTICS, INC.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 2406 SUSANNAH ST LOWER LEVEL
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1725
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Country | US
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Telephone | 423-975-5462
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Fax | 423-975-5463
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Provider Business Mailing Address
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Address Line | 2406 SUSANNAH ST LOWER LEVEL
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1725
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Country | US
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Telephone | 423-975-5462
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Fax | 423-975-5463
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Authorized Official
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Title or Position | PROTHETIST, ORTHOTIST,, PEDORTHIST
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Name | MR. CALVIN K HOYLE
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Credential | CP, BOCO, CPED
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Telephone | 423-975-5462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | TN
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