Provider Demographics
NPI:1639440126
Name:FOOT SOLUTIONS OF FORT WORTH, INC.
Entity Type:Organization
Organization Name:FOOT SOLUTIONS OF FORT WORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE-JOSE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-423-3668
Mailing Address - Street 1:4825 OVERTON RIDGE BLVD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1423
Mailing Address - Country:US
Mailing Address - Phone:817-423-3668
Mailing Address - Fax:817-423-3671
Practice Address - Street 1:4825 OVERTON RIDGE BLVD
Practice Address - Street 2:SUITE 316
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1423
Practice Address - Country:US
Practice Address - Phone:817-423-3668
Practice Address - Fax:817-423-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier