MEDICARE: ON THE MOVE PODIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QP1100X	Podiatric Clinic/Center
3	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1285218750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE MOVE PODIATRY LLC

Provider Business Mailing Address
First Line	:	19636 N 27TH AVE STE 301
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4016
Country	:	US
Telephone Number	:	602-993-2700
Fax Number	:	602-993-2705

Provider Business Practice Location Address
First Line	:	19636 N 27TH AVE STE 207
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4015
Country	:	US
Telephone Number	:	602-993-2700
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHELLY FERRULLI
Credential	:
Telephone Number	:	602-993-2700

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	02/16/2022

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Directions to “ON THE MOVE PODIATRY LLC ” Practice Location

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