Provider Demographics
NPI:1750550497
Name:FOOTTENT LLC
Entity type:Organization
Organization Name:FOOTTENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRYNN
Authorized Official - Middle Name:CHERIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-562-8650
Mailing Address - Street 1:3392 W 8600 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9706
Mailing Address - Country:US
Mailing Address - Phone:801-562-8650
Mailing Address - Fax:801-566-1129
Practice Address - Street 1:3392 W 8600 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9706
Practice Address - Country:US
Practice Address - Phone:801-562-8650
Practice Address - Fax:801-566-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT25163332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment