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General NPI Number Information
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NPI Number | 1689499436
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Entity Type | Organization
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Legal Business Name | REBEL FOOT & ANKLE
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 1601 VETERANS DR UNIT 112
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City | SCOTTSBORO
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State | AL
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Zip | 35769-3716
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Country | US
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Telephone | 801-889-5324
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 GADSDEN HWY SUITE #116 UNIT #2433
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3103
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Country | US
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Telephone | 801-889-5324
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. RYAN KITTERMAN
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Credential | DPM
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Telephone | 801-889-5324
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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 |
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License Number State |
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