Provider Demographics
NPI:1922164219
Name:AT HOME FOOTCARE LLC
Entity Type:Organization
Organization Name:AT HOME FOOTCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUSHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-497-0420
Mailing Address - Street 1:53 E 950 S
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2837
Mailing Address - Country:US
Mailing Address - Phone:801-497-0420
Mailing Address - Fax:
Practice Address - Street 1:53 E 950 S
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2837
Practice Address - Country:US
Practice Address - Phone:801-497-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47649170501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000060148Medicare PIN
5849580001Medicare NSC