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NPI Code Detail

MEDICARE: DR. FRANK FODERARO DPT

MEDICARE: DR. FRANK FODERARO DPT
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
12251S0007XSports Physical TherapistP20769NC

General Provider Information

NPI Number : 1811851561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRANK FODERARO DPT
Provider Business Mailing Address
First Line : 1632 CROWNE PARK DR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-6341
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 830 ROCKFORD ST
Second Line :
City : MOUNT AIRY
State : NC
Zip : 27030-5322
Country : US
Telephone Number : 336-719-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2025
Last Update Date : 12/17/2025

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Directions to “ DR. FRANK FODERARO DPT” Practice Location

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