MEDICARE: FUSION FOOTWEAR, 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1720964737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUSION FOOTWEAR, LLC

Provider Business Mailing Address
First Line	:	8036 CAMP BOWIE WEST BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6313
Country	:	US
Telephone Number	:	817-886-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	8036 CAMP BOWIE WEST BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6313
Country	:	US
Telephone Number	:	817-840-6769
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. CLAIR RIZK
Credential	:
Telephone Number	:	817-840-6769

Provider Enumeration Date	:	08/14/2025
Last Update Date	:	08/14/2025

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