Healthcare Provider Details

I. General information

NPI: 1598776833
Provider Name (Legal Business Name): FLEETWOOD FOOTCARE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date: 05/05/2008
Reactivation Date: 06/04/2008

III. Provider practice location address

12 LENHART RD
FLEETWOOD PA
19522-8613
US

IV. Provider business mailing address

12 LENHART RD PO BOX 425
FLEETWOOD PA
19522-0425
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-6537
  • Fax: 610-944-8152
Mailing address:
  • Phone: 610-944-6537
  • Fax: 610-944-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StatePA

VIII. Authorized Official

Name: KATHY L GEIST
Title or Position: CREDENTIALING
Credential:
Phone: 610-944-6537