Organization
MODERN SHOE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY C THOMAS (PRESIDENT)
(801) 375-2711
Entity
Organization
Contact information
Practice address
350 W CENTER ST, PROVO, UT 84601-4323
(801) 375-2711
(801) 371-0060
Mailing address
350 W CENTER ST, PROVO, UT 84601-4323
(801) 375-2711
(801) 371-0060
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/15/2007
Last updated
05/28/2010
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