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General NPI Number Information
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NPI Number | 1467090639
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Entity Type | Organization
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Legal Business Name | ANKLE FOOT AND LEG CENTERS INC.
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 3075 CHESTNUT RIDGE WAY
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City | ORANGE PARK
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State | FL
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Zip | 32065-3629
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Country | US
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Telephone | 321-591-8039
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Fax | 904-467-3577
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Provider Business Mailing Address
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Address Line | 3075 CHESTNUT RIDGE WAY
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City | ORANGE PARK
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State | FL
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Zip | 32065-3629
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Country | US
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Telephone | 321-591-8039
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Fax | 904-467-3577
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEDRICK MICHELLE DANIELS
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Credential | DPM
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Telephone | 202-276-9478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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