Provider Demographics
NPI:1053321711
Name:FOOTSTEPS,LLC
Entity Type:Organization
Organization Name:FOOTSTEPS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:225-756-0034
Mailing Address - Street 1:PO BOX 86124
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-6124
Mailing Address - Country:US
Mailing Address - Phone:225-756-0034
Mailing Address - Fax:225-756-0708
Practice Address - Street 1:2647 S RIVERVIEW BLVD
Practice Address - Street 2:SUITE 316
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5021
Practice Address - Country:US
Practice Address - Phone:225-756-0034
Practice Address - Fax:225-756-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD321R332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies