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General NPI Number Information
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NPI Number | 1811177975
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT HEALTH CENTER INC.
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 11212 SUNRISE BLVD E # 203
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City | PUYALLUP
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State | WA
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Zip | 98374-8847
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Country | US
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Telephone | 253-841-4262
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Fax | 253-841-7112
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Provider Business Mailing Address
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Address Line | 11212 SUNRISE BLVD E # 203
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City | PUYALLUP
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State | WA
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Zip | 98374-8847
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Country | US
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Telephone | 253-841-4262
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Fax | 253-841-7112
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. TIMOTHY S GRACE
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Credential | DPM
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Telephone | 253-841-4262
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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 00000441
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License Number State | WA
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