Healthcare Provider Details

I. General information

NPI: 1568204279
Provider Name (Legal Business Name): TOE-TALLY AWESOME FEET, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 E HERNDON AVE STE 106
FRESNO CA
93720-3377
US

IV. Provider business mailing address

1642 E HERNDON AVE STE 106
FRESNO CA
93720-3377
US

V. Phone/Fax

Practice location:
  • Phone: 559-552-0522
  • Fax: 559-257-2886
Mailing address:
  • Phone: 559-552-0522
  • Fax: 559-257-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KATHRYNE RUPLEY
Title or Position: PRESIDENT
Credential: DPM
Phone: 559-269-2821