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General NPI Number Information
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NPI Number | 1740333061
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Entity Type | Organization
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Legal Business Name | FOOT CARE STORE, LLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 3281 FAIRLANE FARMS RD STE 4
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City | WELLINGTON
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State | FL
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Zip | 33414-6503
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Country | US
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Telephone | 561-791-1213
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Fax | 561-791-9919
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Provider Business Mailing Address
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Address Line | 3281 FAIRLANE FARMS RD STE 4
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City | WELLINGTON
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State | FL
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Zip | 33414-6503
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Country | US
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Telephone | 561-791-1213
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Fax | 561-791-9919
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Authorized Official
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Title or Position | DIRECTOR OF PODIATRY
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Name | ROBERT M GAYNOR
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Credential | DPM
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Telephone | 561-721-7063
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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 | PO1985
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License Number State | FL
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