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General NPI Number Information
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NPI Number | 1902986748
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Entity Type | Organization
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Legal Business Name | FEET 1ST SHOES, INC.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 8081 PHILIPS HWY SUITE 5
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7464
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Country | US
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Telephone | 904-731-3338
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Fax | 904-731-3348
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Provider Business Mailing Address
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Address Line | 8081 PHILIPS HWY STE 4
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7443
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Country | US
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Telephone | 904-731-3338
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Fax | 904-731-3348
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WADE NIELD
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Credential | C.PED.
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Telephone | 904-731-3338
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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 | PED69
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License Number State | FL
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