Provider Demographics
NPI:1558615187
Name:PRESCRIPTION FOOT BALANCE, INC.
Entity Type:Organization
Organization Name:PRESCRIPTION FOOT BALANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-283-3668
Mailing Address - Street 1:1223 THORNDIKE STREET
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1564
Mailing Address - Country:US
Mailing Address - Phone:413-283-3668
Mailing Address - Fax:413-289-1798
Practice Address - Street 1:1223 THORNDIKE STREET
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1564
Practice Address - Country:US
Practice Address - Phone:413-283-3668
Practice Address - Fax:413-289-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies