MEDICARE: CENTRAL TEXAS FOOT SPECIALIST PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	1667	TX

General Provider Information

NPI Number	:	1689818684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL TEXAS FOOT SPECIALIST PA

Provider Business Mailing Address
First Line	:	3007 DAWN DR STE 101
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2864
Country	:	US
Telephone Number	:	512-819-4555
Fax Number	:	512-819-4559

Provider Business Practice Location Address
First Line	:	3007 DAWN DR STE 101
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2864
Country	:	US
Telephone Number	:	512-819-4555
Fax Number	:	512-819-4559

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RENEE KUKLA PIETZSCH
Credential	:	DPM
Telephone Number	:	512-819-4555

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	03/04/2026

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Directions to “CENTRAL TEXAS FOOT SPECIALIST PA ” Practice Location

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