Provider Demographics
NPI:1376951301
Name:FORRESTER FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:FORRESTER FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:KAY-DAWN
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-921-5413
Mailing Address - Street 1:5232 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3640
Mailing Address - Country:US
Mailing Address - Phone:215-921-5413
Mailing Address - Fax:215-921-5413
Practice Address - Street 1:5232 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-3640
Practice Address - Country:US
Practice Address - Phone:215-921-5413
Practice Address - Fax:215-921-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006280261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric