Provider Demographics
NPI:1710695069
Name:HEAD TO TOE HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:HEAD TO TOE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:623-640-4792
Mailing Address - Street 1:PO BOX 7744
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0646
Mailing Address - Country:US
Mailing Address - Phone:623-640-4792
Mailing Address - Fax:
Practice Address - Street 1:16196 W GIBSON LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3448
Practice Address - Country:US
Practice Address - Phone:623-640-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty