Organization
2ND SOLE-CUSTOM SHOES & ORTHOTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADY BENJAMIN ELLIOTT C.PED, CFO (VICE-PRESIDENT)
(530) 872-3710
Entity
Organization
Contact information
Practice address
5923 CLARK RD, SUITE C, PARADISE, CA 95969-4866
(530) 872-3710
(530) 872-7234
Mailing address
5923 CLARK RD, SUITE C, PARADISE, CA 95969-4866
(530) 872-3710
(530) 872-7234
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
03/08/2007
Last updated
01/05/2015
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