Healthcare Provider Details

I. General information

NPI: 1346265261
Provider Name (Legal Business Name): NORTHWEST FOOT & ANKLE CENTER, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 TALBOT RD S SUITE 102
RENTON WA
98055-6238
US

IV. Provider business mailing address

4300 TALBOT RD S SUITE 102
RENTON WA
98055-6238
US

V. Phone/Fax

Practice location:
  • Phone: 425-277-3668
  • Fax: 425-277-0732
Mailing address:
  • Phone: 425-277-3668
  • Fax: 425-277-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number602113454
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PETRINA CELESTE LEWIS
Title or Position: OWNER
Credential: DPM
Phone: 425-277-3668