Healthcare Provider Details

I. General information

NPI: 1457351132
Provider Name (Legal Business Name): ANKLE AND FOOT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 BLANEY RD SUITE A
KITTANNING PA
16201-3568
US

IV. Provider business mailing address

186 BLANEY RD SUITE A
KITTANNING PA
16201-3568
US

V. Phone/Fax

Practice location:
  • Phone: 724-543-3668
  • Fax: 724-543-2087
Mailing address:
  • Phone: 724-543-3668
  • Fax: 724-543-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN A MARTY JR.
Title or Position: PRESIDENT
Credential: DPM
Phone: 724-543-3668