Healthcare Provider Details

I. General information

NPI: 1962890293
Provider Name (Legal Business Name): FIT FOOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 SNOW ST STE B
OXFORD AL
36203-1294
US

IV. Provider business mailing address

1209 SNOW ST STE B
OXFORD AL
36203-1294
US

V. Phone/Fax

Practice location:
  • Phone: 256-283-4355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number589
License Number StateAL

VIII. Authorized Official

Name: AARON ANDERSON
Title or Position: PEDORTHIST/CLINICAL DIRECTOR
Credential:
Phone: 256-283-4355