Organization
PARK CITY PEDORTHICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TASHA GLEASON C.PED (OWNER)
(715) 203-5730
Entity
Organization
Contact information
Practice address
902 E 1ST ST, MERRILL, WI 54452-2508
(715) 203-5730
Mailing address
902 E 1ST ST, MERRILL, WI 54452-2508
(715) 203-5730
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
11/22/2019
Last updated
01/23/2020
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