Organization
FOOT FORM SHOES, INC.
Active
Other names
Berkshire Boot & Shoe Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PERRY VICTOR CLISSA CERTIFIED PEDORTHIST (PRESIDENT)
(610) 370-2323
Entity
Organization
Contact information
Practice address
3981 PERKIOMEN AVE, READING, PA 19606-2718
(610) 370-2323
(610) 370-2932
Mailing address
3981 PERKIOMEN AVE, READING, PA 19606-2718
(610) 370-2323
(610) 370-2932
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/17/2007
Last updated
02/25/2008
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