Provider Demographics
NPI:1720174675
Name:THE SHOE FITS AT 1 FOOT 2 FOOT LLC
Entity Type:Organization
Organization Name:THE SHOE FITS AT 1 FOOT 2 FOOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:DAIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, FACFAS
Authorized Official - Phone:757-934-0768
Mailing Address - Street 1:PO BOX 55350
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-9350
Mailing Address - Country:US
Mailing Address - Phone:757-318-7002
Mailing Address - Fax:757-318-7003
Practice Address - Street 1:173 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4507
Practice Address - Country:US
Practice Address - Phone:757-934-0768
Practice Address - Fax:757-925-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5966790001OtherMEDICARE DMERC
5966790001OtherMEDICARE DMERC