Healthcare Provider Details

I. General information

NPI: 1720153273
Provider Name (Legal Business Name): FOOT AND ANKLE INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLLIER DR UNIT C
DOYLESTOWN OH
44230-9757
US

IV. Provider business mailing address

PO BOX 268
DOYLESTOWN OH
44230-0268
US

V. Phone/Fax

Practice location:
  • Phone: 330-658-2083
  • Fax: 330-658-3387
Mailing address:
  • Phone: 330-658-2083
  • Fax: 330-658-3387

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