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General NPI Number Information
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NPI Number | 1962542019
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Entity Type | Organization
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Legal Business Name | FOOTWEAR BY DESIGN
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 1967 LONGWOOD LAKE MARY RD SUITE 1001
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City | LONGWOOD
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State | FL
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Zip | 32750-4673
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Country | US
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Telephone | 407-323-7441
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Fax | 407-323-1964
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Provider Business Mailing Address
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Address Line | 1967 LONGWOOD LAKE MARY RD SUITE 1001
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City | LONGWOOD
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State | FL
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Zip | 32750-4673
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Country | US
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Telephone | 407-323-7441
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Fax | 407-323-1964
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELA ANN ECKENRODE
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Credential | L.C.PED
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Telephone | 407-323-7441
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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 | PED154
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License Number State | FL
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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 | PED154
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License Number State | FL
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