Healthcare Provider Details

I. General information

NPI: 1346067154
Provider Name (Legal Business Name): FOOTWORKS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 LARKSPUR RD
PASCO WA
99301-8796
US

IV. Provider business mailing address

271 LARKSPUR RD
PASCO WA
99301-8796
US

V. Phone/Fax

Practice location:
  • Phone: 509-295-1827
  • Fax:
Mailing address:
  • Phone: 509-295-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN LARRY FREEMAN
Title or Position: PODIATRIST
Credential: PO
Phone: 509-295-1827