=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922871326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM TREE PODIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2023
-----------------------------------------------------
Last Update Date | 11/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 BELLE TERRE PKWY STE 112
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-777-7311
-----------------------------------------------------
Fax | 386-777-7312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 BELLE TERRE PKWY STE 112
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32164-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-777-7311
-----------------------------------------------------
Fax | 386-777-7312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ERIC WILLIAM FREILER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 386-777-7311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------