Provider Demographics
NPI:1194202887
Name:NORTHSTATE FOOT & ANKLE SPECIALIST INC
Entity Type:Organization
Organization Name:NORTHSTATE FOOT & ANKLE SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PASAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-891-3338
Mailing Address - Street 1:1806 FOUNDATION LANE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-891-3338
Mailing Address - Fax:530-894-5771
Practice Address - Street 1:1806 FOUNDATION LANE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-891-3338
Practice Address - Fax:530-894-5771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSTATE FOOT & ANKLE SPECIALIST INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-25
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty