Organization
PROFESSIONAL FOOTWEAR LLC
Active
Other names
dba The Fitted Foot
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY L. NICHALSON (MANAGER)
(812) 522-3800
Entity
Organization
Contact information
Practice address
1239 E 4TH STREET RD, SEYMOUR, IN 47274-1839
(812) 522-3800
(812) 522-3883
Mailing address
PO BOX 707, SEYMOUR, IN 47274-0707
(812) 522-3800
(812) 522-3883
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200904040 A
—
IN
Enumeration date
05/16/2006
Last updated
07/14/2015
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