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General NPI Number Information
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NPI Number | 1639439409
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Entity Type | Organization
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Legal Business Name | KUTCHBACK PODIATRY, PA
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 17191 ST LUKES WAY SUITE 290
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City | THE WOODLANDS
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State | TX
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Zip | 77384-8042
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Country | US
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Telephone | 936-273-3311
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Fax | 936-273-3368
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Provider Business Mailing Address
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Address Line | 71 N SUMMER CLOUD DR
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City | THE WOODLANDS
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State | TX
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Zip | 77381-6224
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Country | US
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Telephone | 936-273-7831
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Fax | 936-273-7831
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Authorized Official
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Title or Position | OFFICE CONTACT
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Name | MRS. ELIZABETH KUTCHBACK
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Credential |
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Telephone | 936-273-7831
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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 | 1755
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License Number State | TX
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