MEDICARE: FOUNDATIONS FOOTWEAR, 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	335E00000X	Prosthetic/Orthotic Supplier	2940	TX

General Provider Information

NPI Number	:	1558692863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS FOOTWEAR, INC.

Provider Business Mailing Address
First Line	:	4006 CORTINA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4924
Country	:	US
Telephone Number	:	512-914-8338
Fax Number	:	512-478-4225

Provider Business Practice Location Address
First Line	:	422 W RIVERSIDE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-1229
Country	:	US
Telephone Number	:	512-914-8338
Fax Number	:	512-478-4225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM FRENCH STONE IV
Credential	:	C. PED.
Telephone Number	:	512-914-8338

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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