Healthcare Provider Details

I. General information

NPI: 1922871326
Provider Name (Legal Business Name): PALM TREE PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BELLE TERRE PKWY STE 112
PALM COAST FL
32164-2315
US

IV. Provider business mailing address

800 BELLE TERRE PKWY STE 112
PALM COAST FL
32164-2315
US

V. Phone/Fax

Practice location:
  • Phone: 386-777-7311
  • Fax: 386-777-7312
Mailing address:
  • Phone: 386-777-7311
  • Fax: 386-777-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC WILLIAM FREILER
Title or Position: OWNER
Credential: DPM
Phone: 386-777-7311