Provider Demographics
NPI:1093887564
Name:WHEN THE SHOE FITS
Entity Type:Organization
Organization Name:WHEN THE SHOE FITS
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-739-3668
Mailing Address - Street 1:7060 VALLEY CREEK PLZ
Mailing Address - Street 2:SUITE 113
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2269
Mailing Address - Country:US
Mailing Address - Phone:651-739-3668
Mailing Address - Fax:651-739-3678
Practice Address - Street 1:7060 VALLEY CREEK PLZ
Practice Address - Street 2:SUITE 113
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2269
Practice Address - Country:US
Practice Address - Phone:651-739-3668
Practice Address - Fax:651-739-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
164941OtherUCARE
206L2FOOtherBLUE CROSS
MN4898860001Medicare NSC