MEDICARE: PORTABLE PODIATRY, PLLC

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	213EP1101X	Primary Podiatric Medicine Podiatrist	1895	TX

General Provider Information

NPI Number	:	1841653177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTABLE PODIATRY, PLLC

Provider Business Mailing Address
First Line	:	16806 AMY RIDGE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-5328
Country	:	US
Telephone Number	:	281-748-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 W DREW ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-2002
Country	:	US
Telephone Number	:	713-533-0848
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHERESE THOMAS-RAMOUTAR
Credential	:	D.P.M.
Telephone Number	:	281-748-6848

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	04/04/2016

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