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General NPI Number Information
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NPI Number | 1548378110
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA FOOT CARE, P.A.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 305 CHILDS ST
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City | LEESBURG
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State | FL
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Zip | 34748
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Country | US
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Telephone | 352-360-1360
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Fax | 352-360-0686
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Provider Business Mailing Address
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Address Line | PO BOX 491334
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City | LEESBURG
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State | FL
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Zip | 34749-1334
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Country | US
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Telephone | 352-360-1360
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Fax | 352-360-0686
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS PRZYSTAWSKI
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Credential | D.P.M.
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Telephone | 352-360-1360
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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 | PO 2004
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License Number State | FL
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