Healthcare Provider Details

I. General information

NPI: 1013821149
Provider Name (Legal Business Name): PODIATRY ASSOCIATES OF BURLESON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11807 SOUTH FWY STE 361
BURLESON TX
76028-7045
US

IV. Provider business mailing address

4202 SPRING LAKE PKWY
MANSFIELD TX
76063-5861
US

V. Phone/Fax

Practice location:
  • Phone: 817-704-4223
  • Fax: 817-984-3970
Mailing address:
  • Phone: 817-704-4223
  • Fax: 817-984-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUDY SALANO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 817-704-4223