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Organization
BRUSH MOUNTAIN SHOE
Active
Organization
BRUSH MOUNTAIN SHOE
Active
Other names
Lasser's Shoe Fly
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES WAYNE BIDDLE (SECRETARY)
(814) 684-8040
Entity
Organization
Contact information
Practice address
3415 PLEASANT VALLEY BLVD, ALTOONA, PA 16602-4321
(814) 941-2132
(814) 941-4491
Mailing address
3415 PLEASANT VALLEY BLVD, ALTOONA, PA 16602-4321
(814) 941-2132
(814) 941-4491
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
BCP9905
PA
Other
Enumeration date
07/11/2006
Last updated
05/21/2008
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