Provider Demographics
NPI:1235703844
Name:TEXAS MOBILE PODIATRY PLLC
Entity Type:Organization
Organization Name:TEXAS MOBILE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOODLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:682-323-9205
Mailing Address - Street 1:7208 GLENVIEW DR STE B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8693
Mailing Address - Country:US
Mailing Address - Phone:682-323-9205
Mailing Address - Fax:
Practice Address - Street 1:7208 GLENVIEW DR STE B
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8693
Practice Address - Country:US
Practice Address - Phone:682-323-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty