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General NPI Number Information
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NPI Number | 1336355577
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Entity Type | Organization
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Legal Business Name | FOOT DYNAMICS INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 2030 POWERS FERRY RD SE STE 540
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City | ATLANTA
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State | GA
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Zip | 30339-5032
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Country | US
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Telephone | 770-582-1122
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Fax | 770-582-1133
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Provider Business Mailing Address
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Address Line | 51 CHERT RD
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City | MARIETTA
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State | GA
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Zip | 30062-3629
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Country | US
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Telephone | 770-582-1122
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Fax | 770-582-1133
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Authorized Official
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Title or Position | CEO
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Name | RICARDO MARTINEZ
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Credential | CPED
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Telephone | 678-468-7463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | GA
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