Provider Demographics
NPI:1508116419
Name:FIRST STEP PODIATRY, LLC
Entity Type:Organization
Organization Name:FIRST STEP PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIENT
Authorized Official - Prefix:
Authorized Official - First Name:YANICK
Authorized Official - Middle Name:BEAUVOIR
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-350-6699
Mailing Address - Street 1:7857 W. SAMPLE RD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4748
Mailing Address - Country:US
Mailing Address - Phone:561-350-6699
Mailing Address - Fax:954-757-7009
Practice Address - Street 1:7857 W. SAMPLE RD
Practice Address - Street 2:SUITE 157
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4748
Practice Address - Country:US
Practice Address - Phone:561-350-6699
Practice Address - Fax:954-757-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty