Healthcare Provider Details

I. General information

NPI: 1669478202
Provider Name (Legal Business Name): SARASOTA FOOT CARE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST STE 106
SARASOTA FL
34239-2941
US

IV. Provider business mailing address

1921 WALDEMERE ST STE 106
SARASOTA FL
34239-2941
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-6232
  • Fax: 941-917-6234
Mailing address:
  • Phone: 941-917-6232
  • Fax: 941-917-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21570
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number21570
License Number StateFL

VIII. Authorized Official

Name: JEFFREY M SPIEGEL
Title or Position: PRESIDENT
Credential: DPM
Phone: 941-917-6232