Italy Shoe Lab, Inc
Organization Active NPI Prosthetic/Orthotic Supplier · Wimauma, FL
NPI 1962455873 · NPPES record last updated Feb 27, 2008
Key facts
- NPI
- 1962455873
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Prosthetic/Orthotic Supplier 335E00000X
- License
- NO PED 76 (FL)
- Legal business name
- ITALY SHOE LAB, INC
- Practice address
- 16621 Hwy 301 S
#107
Wimauma, FL 33598 - Phone
- (813) 645-5800
- Fax
- (813) 641-0319
- NPI assigned
- May 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Jeffrey M Corniello, CPED
- Title
- Vice-President
- Phone
- (813) 645-5800
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Italy Shoe Lab Inc
Locations
16621 S US Highway 301
#107
Wimauma, FL 33598
Phone (813) 645-5800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | NO PED 76 | FL | Yes |
Addresses
Primary practice location
16621 Hwy 301 S
#107
Wimauma, FL 33598
Mailing address
13521 Mango Bay Dr
Riverview, FL 33579-2336
Phone (813) 645-5800
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All providers in Wimauma, FL · Prosthetic/Orthotic Supplier in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.