Provider Demographics
NPI:1033654199
Name:MY FOOT RX LLC
Entity Type:Organization
Organization Name:MY FOOT RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MC ROBERTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPED
Authorized Official - Phone:715-568-1500
Mailing Address - Street 1:1706 YORK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1921
Mailing Address - Country:US
Mailing Address - Phone:715-568-1500
Mailing Address - Fax:715-568-1501
Practice Address - Street 1:1706 YORK ST
Practice Address - Street 2:UNIT #3
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-1920
Practice Address - Country:US
Practice Address - Phone:715-577-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment