Provider Demographics
NPI:1558577718
Name:FROM THE SOLE, INC.
Entity Type:Organization
Organization Name:FROM THE SOLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:386-672-9394
Mailing Address - Street 1:1520 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-2220
Mailing Address - Country:US
Mailing Address - Phone:386-672-9394
Mailing Address - Fax:386-672-4310
Practice Address - Street 1:1520 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-2220
Practice Address - Country:US
Practice Address - Phone:386-672-9394
Practice Address - Fax:386-672-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED-44335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1204130001Medicare ID - Type Unspecified