BRUSH MOUNTAIN SHOE NPI 1366476608

NPI Information

  • NPI: 1366476608
  • Provider Name: BRUSH MOUNTAIN SHOE
  • Classification: Podiatrist - 213E00000X
  • Entity Type: Organization
  • Doing Business As: LASSER'S SHOE FLY
  • Address: 3415 PLEASANT VALLEY BLVD
    ALTOONA, PA
    ZIP 16602
  • Phone: (814) 941-2132

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NPI Details

BRUSH MOUNTAIN SHOE is a podiatrist in Altoona, PA. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. BRUSH MOUNTAIN SHOE NPI is 1366476608. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Lasser's Shoe Fly.

The provider's business location address is:

3415 PLEASANT VALLEY BLVD
ALTOONA, PA
ZIP 16602-321
Phone: (814) 941-2132
Fax: (814) 941-4491

The provider's authorized official is Charles Wayne Biddle .
The authorized official title is Secretary and has the following contact phone number (814) 684-8040.

The enumeration date for this NPI number is 7/11/2006 and was last updated on 5/21/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213E00000XPodiatristBCP9905PENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
15337390001MEDICARE NSCPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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