Organization
FOOTSTEPS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER B FORMANEK (OWNER)
(225) 756-0034
Entity
Organization
Contact information
Practice address
826 W HIGHWAY 30 STE A, GONZALES, LA 70737-4852
(225) 803-1516
Mailing address
6141 PARKFOREST DR, BATON ROUGE, LA 70816-6111
(225) 756-0034
(225) 756-0708
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1173576
—
LA
Enumeration date
12/17/2018
Last updated
05/10/2021
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