MEDICARE: FOOT TREATMENT CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1043322118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT TREATMENT CENTER, INC.

Provider Business Mailing Address
First Line	:	1255 W 46TH ST
Second Line	:	SUITE 10
City	:	HIALEAH
State	:	FL
Zip	:	33012-3283
Country	:	US
Telephone Number	:	305-828-9383
Fax Number	:	305-822-0109

Provider Business Practice Location Address
First Line	:	1255 W 46TH ST
Second Line	:	SUITE 10
City	:	HIALEAH
State	:	FL
Zip	:	33012-3283
Country	:	US
Telephone Number	:	305-828-9383
Fax Number	:	305-822-0109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SAMUEL GENDRIZ
Credential	:
Telephone Number	:	305-828-9383

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/20/2015

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