Provider Demographics
NPI:1346664281
Name:AGILITY FOOT & ANKLE SPECIALTY CENTER LLC
Entity Type:Organization
Organization Name:AGILITY FOOT & ANKLE SPECIALTY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARBY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:567-890-3668
Mailing Address - Street 1:405 MYERS RD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1132
Mailing Address - Country:US
Mailing Address - Phone:567-890-3668
Mailing Address - Fax:567-890-3670
Practice Address - Street 1:405 MYERS RD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1132
Practice Address - Country:US
Practice Address - Phone:567-890-3668
Practice Address - Fax:567-890-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2017-02-22
Deactivation Date:2016-12-20
Deactivation Code:
Reactivation Date:2017-02-22
Provider Licenses
StateLicense IDTaxonomies
OH36.003444213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7088150002Medicare NSC