Healthcare Provider Details

I. General information

NPI: 1912072810
Provider Name (Legal Business Name): FOOT AND ANKLE INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N 1ST ST
DENNISON OH
44621-1003
US

IV. Provider business mailing address

1193 NORTON AVE STE D
NORTON OH
44203-9516
US

V. Phone/Fax

Practice location:
  • Phone: 740-922-1188
  • Fax: 330-595-4729
Mailing address:
  • Phone: 330-725-7878
  • Fax: 330-595-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-002891
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36-002891
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number36-002891
License Number StateOH

VIII. Authorized Official

Name: JON OLIVERIO
Title or Position: OWNER
Credential: DPM
Phone: 330-658-2083