Healthcare Provider Details

I. General information

NPI: 1982115259
Provider Name (Legal Business Name): FIRST STEP FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15003 FM 529 RD
HOUSTON TX
77095-4375
US

IV. Provider business mailing address

PO BOX 50
STAFFORD TX
77497-0050
US

V. Phone/Fax

Practice location:
  • Phone: 281-910-7172
  • Fax: 281-503-7812
Mailing address:
  • Phone: 281-910-7172
  • Fax: 281-503-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2189
License Number StateTX

VIII. Authorized Official

Name: REBEKAH DENISE FONTENOT
Title or Position: OWNER
Credential: DPM
Phone: 281-910-7172