Organization
ITALY SHOE LAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY JAMES CORNIELLO PEDORTHIST (PEDORTHIST)
(813) 645-5800
Entity
Organization
Contact information
Practice address
9639 PALM RIVER RD, TAMPA, FL 33619-4433
(813) 744-5155
Mailing address
13521 MANGO BAY DR, RIVERVIEW, FL 33569-2336
(813) 645-5800
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PED 76
FL
Other
Enumeration date
04/04/2007
Last updated
08/22/2020
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