Organization
THE SHOE LAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY J CORNIELLO PEDORTHIST PED 76 (PRESIDENT)
(813) 645-5800
Entity
Organization
Contact information
Practice address
1201 1ST ST SW, RUSKIN, FL 33570
(813) 645-5800
(813) 641-0319
Mailing address
1201 1ST ST SW, RUSKIN, FL 33570-5345
(813) 645-5800
(813) 641-0319
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PED 76
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001855300
—
FL
Enumeration date
01/11/2008
Last updated
08/31/2018
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