Provider Demographics
NPI:1225170079
Name:FOOT FITNESS
Entity Type:Organization
Organization Name:FOOT FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:503-364-6006
Mailing Address - Street 1:2200 NE NEFF RD
Mailing Address - Street 2:STE 307
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-389-5422
Mailing Address - Fax:541-389-7656
Practice Address - Street 1:2200 NE NEFF RD
Practice Address - Street 2:STE 307
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-389-5422
Practice Address - Fax:541-389-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier