Healthcare Provider Details

I. General information

NPI: 1750570099
Provider Name (Legal Business Name): ABSOLUTE PODIATRY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15228 E COLONIAL DR
ORLANDO FL
32826-5134
US

IV. Provider business mailing address

PO BOX 677970
ORLANDO FL
32867-7970
US

V. Phone/Fax

Practice location:
  • Phone: 407-568-9020
  • Fax:
Mailing address:
  • Phone: 407-568-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2625
License Number StateFL

VIII. Authorized Official

Name: MISS VICTORIA ELIZABETH GOITZ
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 407-568-9020