Healthcare Provider Details

I. General information

NPI: 1689818684
Provider Name (Legal Business Name): CENTRAL TEXAS FOOT SPECIALIST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 WILLIAMS DR STE 120
GEORGETOWN TX
78628-2891
US

IV. Provider business mailing address

3316 WILLIAMS DR STE 120
GEORGETOWN TX
78628-2891
US

V. Phone/Fax

Practice location:
  • Phone: 512-819-4555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1667
License Number StateTX

VIII. Authorized Official

Name: RENEE KUKLA PIETZSCH
Title or Position: PRESIDENT
Credential: DPM
Phone: 512-819-4555