Foot Form Shoes, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

FOOT FORM SHOES, INC.

Doing business as

Berkshire Boot & Shoe Shoppe

Practice address

3981 Perkiomen Ave
Reading, PA 19606-2718

Phone

(610) 370-2323

Fax

(610) 370-2932

NPI assigned

Feb 17, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Perry Victor Clissa, CERTIFIED PEDORTHIST

Title

President

Phone

(610) 370-2323

Specialties & licenses 1

Addresses

Other names 1

• Berkshire Boot & Shoe Shoppe Doing business as

Locations

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

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1992849434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3981 PERKIOMEN AVE",
            "city": "READING",
            "state": "PA",
            "postal_code": "196062718",
            "telephone_number": "610-370-2323",
            "fax_number": "610-370-2932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3981 PERKIOMEN AVE",
            "city": "READING",
            "state": "PA",
            "postal_code": "196062718",
            "telephone_number": "610-370-2323",
            "fax_number": "610-370-2932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT FORM SHOES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-17",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "CLISSA",
        "authorized_official_first_name": "PERRY",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-370-2323",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CERTIFIED PEDORTHIST"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkshire Boot & Shoe Shoppe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Cody Forsythe, LCSW
• Sonya M Foster-Merrow, MD
• Cerisse L Foster
• David H Foster, O.D.

• Prosthetic/Orthotic Supplier in Reading, PA
• Providers in Reading, PA by specialty
• Prosthetic/Orthotic Supplier in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; 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.