Provider Demographics
NPI:1952863235
Name:ACTIVE FOOT AND ANKLE CARE LLC
Entity Type:Organization
Organization Name:ACTIVE FOOT AND ANKLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLSOPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-875-2526
Mailing Address - Street 1:11747 FROST RD
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-9109
Mailing Address - Country:US
Mailing Address - Phone:937-681-5266
Mailing Address - Fax:
Practice Address - Street 1:300 S DORSET RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2635
Practice Address - Country:US
Practice Address - Phone:937-681-5266
Practice Address - Fax:937-552-9880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE FOOT AND ANKLE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty