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General NPI Number Information
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NPI Number | 1821987157
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Entity Type | Organization
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Legal Business Name | PORT FOR THE SOLE PODIATRY PLLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 23621 SE H K DODGEN LOOP
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City | TEMPLE
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State | TX
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Zip | 76504-8664
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Country | US
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Telephone | 254-410-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 35 UNITED DR STE 102
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City | WEST BRIDGEWATER
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State | MA
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Zip | 02379-1056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPM
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Name | REBECCA SMITH
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Credential |
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Telephone | 432-266-0209
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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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