Provider Demographics
NPI:1891815072
Name:THERAPEUTIC FOOTWEAR, INC
Entity Type:Organization
Organization Name:THERAPEUTIC FOOTWEAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:253-473-4311
Mailing Address - Street 1:7501 CUSTER RD W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7501 CUSTER RD W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8138
Practice Address - Country:US
Practice Address - Phone:253-473-4311
Practice Address - Fax:253-473-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9037326Medicaid
WA9058579Medicaid
WA095381OtherCOPES SUPPLIER #
WA8383531Medicaid
WA49251OtherL & I SUPPLIER #
WA9037326Medicaid