Organization
PROFESSIONAL FOOTWEAR LLC
Active
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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