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General NPI Number Information
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NPI Number | 1194296087
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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 | 12/17/2018
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 826 W HIGHWAY 30 STE A
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City | GONZALES
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State | LA
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Zip | 70737-4852
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Country | US
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Telephone | 225-803-1516
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Fax |
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Provider Business Mailing Address
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Address Line | 6141 PARKFOREST DR
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City | BATON ROUGE
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State | LA
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Zip | 70816-6111
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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 | OWNER
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Name | CHRISTOPHER B FORMANEK
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Credential |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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