=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265583611
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT SOLUTIONS BOYNTON BEACH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7410 BOYNTON BEACH BLVD STE A-9
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-738-7800
-----------------------------------------------------
Fax | 561-732-1801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7410 BOYNTON BEACH BLVD STE A-9
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33437-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-738-7800
-----------------------------------------------------
Fax | 561-732-1801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MYRNA KUPPERMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-738-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------