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NPI Code Detail

MEDICARE: THE FOOT COMFORT SHOP, INC.

MEDICARE: THE FOOT COMFORT SHOP, 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
1335E00000XProsthetic/Orthotic SupplierPED11FL

General Provider Information

NPI Number : 1578646105
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE FOOT COMFORT SHOP, INC.
Provider Business Mailing Address
First Line : 375 DOUGLAS AVE
Second Line : SUITE 1009
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-3315
Country : US
Telephone Number : 407-834-7463
Fax Number : 407-332-6239
Provider Business Practice Location Address
First Line : 375 DOUGLAS AVE
Second Line : SUITE 1009
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-3315
Country : US
Telephone Number : 407-834-7463
Fax Number : 407-332-6239
Authorized Official
Title or Position : PRESIDENT
Name : JOHN A CAPO
Credential :
Telephone Number : 407-834-7463
Provider Enumeration Date : 10/24/2006
Last Update Date : 06/02/2011

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Directions to “THE FOOT COMFORT SHOP, INC. ” Practice Location

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