Provider Demographics
NPI:1376642876
Name:FIT FEET FOR LIFE, INC.
Entity Type:Organization
Organization Name:FIT FEET FOR LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-460-9468
Mailing Address - Street 1:4040 UPPER CREEK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6844
Mailing Address - Country:US
Mailing Address - Phone:727-824-5100
Mailing Address - Fax:727-824-5132
Practice Address - Street 1:4040 UPPER CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6844
Practice Address - Country:US
Practice Address - Phone:727-824-5100
Practice Address - Fax:727-824-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC9920OtherRAILROAD MEDICARE
FLK3764Medicare ID - Type Unspecified
FL4473390001Medicare NSC