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General NPI Number Information
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NPI Number | 1235480161
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Entity Type | Organization
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Legal Business Name | TOUSSAINT PODIATRY CLINIC, LLC
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 600 N WHEELER AVE
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City | PROSPERITY
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State | SC
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Zip | 29127-9332
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Country | US
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Telephone | 312-339-6498
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N WHEELER AVE
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City | PROSPERITY
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State | SC
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Zip | 29127-9332
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Country | US
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Telephone | 312-339-6498
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CORBETT ELIZABETH TOUSSAINT
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Credential | DPM
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Telephone | 312-339-6498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 619
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License Number State | SC
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