Modern Shoe, Inc.

NPI #1225219587 in Provo, Utah

Provider Information

NPI Number: 1225219587
Entity Type: Organization
Organization Name: Modern Shoe, Inc.
Primary Specialty: Durable Medical Equipment & Medical Supplies
Enumeration Date: Nov 15, 2007
Last Updated: May 28, 2010

Practice Location

Address: 350 W CENTER ST
City: Provo
State: Utah
ZIP Code: 84601-4323
Phone: (801) 375-2711

Authorized Official

Name: ANTHONY C THOMAS
Title: PRESIDENT
Phone: (801) 375-2711

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies	332B00000X	Primary

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