Healthcare Provider Details

I. General information

NPI: 1760781827
Provider Name (Legal Business Name): ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 5TH ST SE STE 4400
PUYALLUP WA
98372-4691
US

IV. Provider business mailing address

1450 5TH ST SE STE 4400
PUYALLUP WA
98372-4691
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-0131
  • Fax: 253-848-6787
Mailing address:
  • Phone: 253-848-0131
  • Fax: 253-848-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMBER HOLLIS
Title or Position: OFFICE ADMIN
Credential:
Phone: 253-256-7048