Provider Demographics
NPI:1538647557
Name:FOOT TREATMENT CENTER INC
Entity Type:Organization
Organization Name:FOOT TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:
Authorized Official - Last Name:PERAZA GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-629-8001
Mailing Address - Street 1:10700 CARIBBEAN BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1233
Mailing Address - Country:US
Mailing Address - Phone:305-629-8002
Mailing Address - Fax:
Practice Address - Street 1:10700 CARIBBEAN BLVD STE 312
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1233
Practice Address - Country:US
Practice Address - Phone:305-629-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty