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General NPI Number Information
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NPI Number | 1356541346
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Entity Type | Organization
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Legal Business Name | ACADEMY FOOT & ANKLE SPECIALISTS, P.A.
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 1940 HIGHWAY 114 STE 150
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6526
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Country | US
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Telephone | 817-424-3668
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Fax | 817-442-8637
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Provider Business Mailing Address
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Address Line | 1940 E STATE HWY 114 SUITE 150
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6526
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Country | US
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Telephone | 817-424-3668
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Fax | 817-442-8637
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRISTINA L NUNEZ
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Credential |
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Telephone | 817-424-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1364
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License Number State | TX
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