Provider Demographics
NPI:1043322118
Name:FOOT TREATMENT CENTER, INC.
Entity type:Organization
Organization Name:FOOT TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GENDRIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-9383
Mailing Address - Street 1:1255 W 46TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3283
Mailing Address - Country:US
Mailing Address - Phone:305-828-9383
Mailing Address - Fax:305-822-0109
Practice Address - Street 1:1255 W 46TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3283
Practice Address - Country:US
Practice Address - Phone:305-828-9383
Practice Address - Fax:305-822-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1259550001Medicare ID - Type Unspecified