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General NPI Number Information
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NPI Number | 1508089954
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Entity Type | Organization
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Legal Business Name | THE FOOTWEAR COMPANY LLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 3 CYPRESS BRANCH WAY SUITE 108A
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City | PALM COAST
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State | FL
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Zip | 32164-8409
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Country | US
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Telephone | 336-446-4226
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Fax | 336-446-4206
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Provider Business Mailing Address
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Address Line | 3 CYPRESS BRANCH WAY SUITE 108A
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City | PALM COAST
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State | FL
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Zip | 32164-8409
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Country | US
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Telephone | 386-447-0560
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Fax | 386-447-0522
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Authorized Official
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Title or Position | OWNER
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Name | FRANK E DENTON
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Credential | PEDORTHIST
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Telephone | 386-447-0560
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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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