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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1538647557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT TREATMENT CENTER INC

Provider Business Mailing Address
First Line	:	10700 CARIBBEAN BLVD STE 312
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1233
Country	:	US
Telephone Number	:	305-629-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 CARIBBEAN BLVD STE 312
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1233
Country	:	US
Telephone Number	:	305-629-8002
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAMILO PERAZA GOMEZ
Credential	:
Telephone Number	:	305-629-8001

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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