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General NPI Number Information
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NPI Number | 1306156534
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Entity Type | Organization
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Legal Business Name | HUNTINGTON COMFORT SHOES AND ORTHOTICS LLC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 2516B 5TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25703-1619
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Country | US
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Telephone | 304-525-7463
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Fax | 304-525-1000
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Provider Business Mailing Address
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Address Line | 2516B 5TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25703-1619
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Country | US
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Telephone | 304-525-7463
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Fax | 304-525-1000
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Authorized Official
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Title or Position | MEMBER
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Name | MR. DAVID CHRIS WOOD
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Credential | CPED
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Telephone | 304-525-7463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number |
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License Number State | WV
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