Healthcare Provider Details

I. General information

NPI: 1588023030
Provider Name (Legal Business Name): 1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 COLISEUM DR STE A
HAMPTON VA
23666-5903
US

IV. Provider business mailing address

171 N MAIN ST
SUFFOLK VA
23434-4507
US

V. Phone/Fax

Practice location:
  • Phone: 579-340-7687
  • Fax: 757-925-1901
Mailing address:
  • Phone: 757-934-0768
  • Fax: 757-925-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0103300887
License Number StateVA

VIII. Authorized Official

Name: MATTHEW C DAIRMAN
Title or Position: OWNER
Credential:
Phone: 757-934-0768