Provider Demographics
NPI:1164065181
Name:FOOTEWORK THERAPY, PLLC
Entity Type:Organization
Organization Name:FOOTEWORK THERAPY, PLLC
Other - Org Name:FOOTEWORK THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:TENNELL
Authorized Official - Last Name:RAMOS-FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:704-561-1019
Mailing Address - Street 1:9004 RAVEN TOP DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3619
Mailing Address - Country:US
Mailing Address - Phone:704-561-1019
Mailing Address - Fax:
Practice Address - Street 1:9004 RAVEN TOP DR
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3619
Practice Address - Country:US
Practice Address - Phone:704-561-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty