Provider Demographics
NPI:1245304385
Name:FOOTWEAR CONSULTANTS, INC
Entity type:Organization
Organization Name:FOOTWEAR CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:B
Authorized Official - Last Name:STRASBURG
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:214-357-3535
Mailing Address - Street 1:6363 FOREST PARK RD
Mailing Address - Street 2:SUITE B-215
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5479
Mailing Address - Country:US
Mailing Address - Phone:214-357-3535
Mailing Address - Fax:
Practice Address - Street 1:6363 FOREST PARK RD
Practice Address - Street 2:SUITE B-215
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5479
Practice Address - Country:US
Practice Address - Phone:214-357-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0870461-01Medicaid
TX0870461-01Medicaid