Healthcare Provider Details

I. General information

NPI: 1952863235
Provider Name (Legal Business Name): ACTIVE FOOT AND ANKLE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S DORSET RD
TROY OH
45373-2635
US

IV. Provider business mailing address

11747 FROST RD
TIPP CITY OH
45371-9109
US

V. Phone/Fax

Practice location:
  • Phone: 937-681-5266
  • Fax: 937-552-9880
Mailing address:
  • Phone: 937-681-5266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY R. HOLSOPPLE
Title or Position: PRESIDENT
Credential: DPM
Phone: 937-875-2526