Organization
ITALY SHOE LAB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY M CORNIELLO CPED (VICE-PRESIDENT)
(813) 645-5800
Entity
Organization
Contact information
Practice address
16621 HWY 301 S, #107, WIMAUMA, FL 33598
(813) 645-5800
(813) 641-0319
Mailing address
13521 MANGO BAY DR, RIVERVIEW, FL 33579-2336
(813) 645-5800
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
NO PED 76
FL
Other
Enumeration date
05/19/2006
Last updated
02/27/2008
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