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General NPI Number Information
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NPI Number | 1316069172
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Entity Type | Organization
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Legal Business Name | THE SHOE DOCTOR, INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 164 NW 51ST ST
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City | BOCA RATON
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State | FL
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Zip | 33431-4226
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Country | US
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Telephone | 561-994-0792
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Fax | 561-241-3899
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Provider Business Mailing Address
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Address Line | 164 NW 51ST ST
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City | BOCA RATON
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State | FL
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Zip | 33431-4226
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Country | US
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Telephone | 561-994-0792
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Fax | 561-241-3899
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES STEINBERG
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Credential | P.D.
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Telephone | 561-994-0792
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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 | 1869147
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License Number State | FL
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