Healthcare Provider Details

I. General information

NPI: 1336207935
Provider Name (Legal Business Name): THE FOOT AND ANKLE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 ROOSEVELT BOULEVARD
PHILADELPHIA PA
19115
US

IV. Provider business mailing address

6921 FRANKFORD AVENUE SUITE D
PHILADELPHIA PA
19135
US

V. Phone/Fax

Practice location:
  • Phone: 215-969-5122
  • Fax: 215-332-5228
Mailing address:
  • Phone: 215-332-5300
  • Fax: 215-332-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TARA L BALSLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-332-5300