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General NPI Number Information
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NPI Number | 1518157387
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Entity Type | Organization
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Legal Business Name | PARK SHOES, INC.
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 245 S US HIGHWAY 1
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City | TEQUESTA
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State | FL
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Zip | 33469-2701
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Country | US
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Telephone | 772-746-3536
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Fax | 772-744-7851
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Provider Business Mailing Address
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Address Line | 245 S. US HIGHWAY 1
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City | TEQUESTA
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State | FL
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Zip | 33469-2701
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Country | US
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Telephone | 772-746-3536
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Fax | 772-744-7851
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. THOMAS CHARLES SCHUEMANN
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Credential |
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Telephone | 561-746-3536
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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 | PED73
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License Number State | FL
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