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NPI Code Detail

MEDICARE: FOOTSTEPS,LLC

MEDICARE: FOOTSTEPS,LLC
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
1332B00000XDurable Medical Equipment & Medical SuppliesPD321RLA

General Provider Information

NPI Number : 1053321711
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOOTSTEPS,LLC
Provider Business Mailing Address
First Line : PO BOX 86124
Second Line :
City : BATON ROUGE
State : LA
Zip : 70879-6124
Country : US
Telephone Number : 225-756-0034
Fax Number : 225-756-0708
Provider Business Practice Location Address
First Line : 2647 S RIVERVIEW BLVD
Second Line : SUITE 316
City : GONZALES
State : LA
Zip : 70737-5021
Country : US
Telephone Number : 225-756-0034
Fax Number : 225-756-0708
Authorized Official
Title or Position : PRESIDENT
Name : DR. CHRISTOPHER FORMANEK
Credential : DPM
Telephone Number : 225-756-0034
Provider Enumeration Date : 08/08/2006
Last Update Date : 08/22/2020

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Directions to “FOOTSTEPS,LLC ” Practice Location

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