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General NPI Number Information
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NPI Number | 1093019713
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Entity Type | Organization
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Legal Business Name | FIRST STEP FOOT AND ANKLE
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 806 HWY 72 E
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City | ROLLA
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State | MO
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Zip | 65401
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Country | US
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Telephone | 573-578-0939
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Fax | 573-426-6051
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Provider Business Mailing Address
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Address Line | 11568 PINE FOREST DR
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City | ROLLA
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State | MO
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Zip | 65401-5427
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Country | US
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Telephone | 573-578-0939
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Fax | 573-426-6051
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Authorized Official
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Title or Position | DOCTOR OF PODIATRIC MEDICINE
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Name | CHRISTOPHER L JOHNSON
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Credential | DPM
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Telephone | 573-578-0939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 000803
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License Number State | MO
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