| Organization Name: | FOOTLOGIC, INC. |
| NPI Number: | 1447276639 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN LYNN WIGGEN (OWNER) |
| Mailing Address: | 107 E Walker St East Flat Rock |
| State: | NC US |
| Postal Code: | 287262235 |
| Phone Number: | 8286970048 |
| Fax Number: | 8286986882 |
| NPI Enumeration Date: | 07/14/2006 |
| NPI Last Update Date: | 02/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1744P3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | Prosthetics Case Management |
| Taxonomy Definition: | |