Professional Footwear LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROFESSIONAL FOOTWEAR LLC

Doing business as

dba The Fitted Foot

Practice address

1239 E 4TH Street Rd
Seymour, IN 47274-1839

Phone

(812) 522-3800

Fax

(812) 522-3883

NPI assigned

May 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Terry L. Nichalson

Title

Manager

Phone

(812) 522-3800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• dba The Fitted Foot Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436832000000",
    "number": "1467403055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 707",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472740707",
            "telephone_number": "812-522-3800",
            "fax_number": "812-522-3883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 E 4TH STREET RD",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472741839",
            "telephone_number": "812-522-3800",
            "fax_number": "812-522-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL FOOTWEAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2015-07-14",
        "status": "A",
        "authorized_official_last_name": "NICHALSON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "812-522-3800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200904040 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba The Fitted Foot",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Seymour, IN
• Providers in Seymour, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.