Healthcare Provider Details

I. General information

NPI: 1174606149
Provider Name (Legal Business Name): WOODLY FOOT AND ANKLE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 GLENVIEW DR
RICHLAND HILLS TX
76180-8693
US

IV. Provider business mailing address

7208 GLENVIEW DR
RICHLAND HILLS TX
76180-8693
US

V. Phone/Fax

Practice location:
  • Phone: 817-284-8271
  • Fax:
Mailing address:
  • Phone: 817-284-8271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1764
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1764
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1764
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1764
License Number StateTX

VIII. Authorized Official

Name: DR. CHARLTON WOODLY
Title or Position: OWNER
Credential: DPM
Phone: 817-284-8271