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General NPI Number Information
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NPI Number | 1457432130
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Entity Type | Organization
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Legal Business Name | FOOT DOCTOR OF RAPPAHANNOCK LTD
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 12010 KILARNEY DR
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City | FREDERICKSBRG
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State | VA
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Zip | 22407-7207
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Country | US
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Telephone | 540-548-3668
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Fax | 540-548-0019
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Provider Business Mailing Address
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Address Line | 12010 KILARNEY DR
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City | FREDERICKSBRG
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State | VA
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Zip | 22407-7207
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Country | US
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Telephone | 540-548-3668
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Fax | 540-548-0019
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Authorized Official
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Title or Position | PODIATRIST OWNER
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Name | DR. ILENE S TERRELL
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Credential | DPM
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Telephone | 540-548-3668
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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 | 0103000702
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License Number State | VA
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