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General NPI Number Information
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NPI Number | 1891939682
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Entity Type | Organization
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Legal Business Name | GENTLE FOOT CARE OF WESTERN OHIO, INC.
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 3800 WOODWARD AVE STE 318
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City | DETROIT
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State | MI
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Zip | 48201-2066
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Country | US
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Telephone | 313-833-3090
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Fax | 313-833-7843
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Provider Business Mailing Address
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Address Line | 3800 WOODWARD AVE STE 318 SUITE 1102
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City | DETROIT
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State | MI
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Zip | 48201-2066
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Country | US
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Telephone | 313-833-3090
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Fax | 313-833-7843
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Authorized Official
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Title or Position | CREDENTIALS SPECIALIST
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Name | CARMEN HENDERSON
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Credential |
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Telephone | 614-457-3212
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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 | 5901002275
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5901002275
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 5901002275
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License Number State | MI
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