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General NPI Number Information
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NPI Number | 1780204602
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Entity Type | Organization
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Legal Business Name | PINNACLE FOOT AND ANKLE CENTERS, LLC
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 1801 SE HILLMOOR DR STE A-103
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7545
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Country | US
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Telephone | 407-844-4499
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 SE HILLMOOR DR STE A-103
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7545
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Country | US
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Telephone | 772-742-7118
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Fax | 772-228-6893
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIELLE MATRECE GREEN-WATSON
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Credential | DPM
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Telephone | 772-742-7118
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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 |
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License Number State |
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