Provider Demographics
NPI:1699407130
Name:PALM TREE PODIATRY PLLC
Entity Type:Organization
Organization Name:PALM TREE PODIATRY PLLC
Other - Org Name:PALM TREE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:FREILER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-838-8057
Mailing Address - Street 1:800 BELLE TERRE PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2315
Mailing Address - Country:US
Mailing Address - Phone:386-777-7311
Mailing Address - Fax:386-777-7312
Practice Address - Street 1:800 BELLE TERRE PKWY STE 112
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2315
Practice Address - Country:US
Practice Address - Phone:386-777-7311
Practice Address - Fax:386-777-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier