MEDICARE: FOOTWEAR CONSULTANTS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245304385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTWEAR CONSULTANTS, INC

Provider Business Mailing Address
First Line	:	6363 FOREST PARK RD
Second Line	:	SUITE B-215
City	:	DALLAS
State	:	TX
Zip	:	75235-5479
Country	:	US
Telephone Number	:	214-357-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	6363 FOREST PARK RD
Second Line	:	SUITE B-215
City	:	DALLAS
State	:	TX
Zip	:	75235-5479
Country	:	US
Telephone Number	:	214-357-3535
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAYMOND B STRASBURG
Credential	:	CPED
Telephone Number	:	214-357-3535

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/26/2011

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