Provider Demographics
NPI:1750725164
Name:ON2FEET, L.L.C.
Entity type:Organization
Organization Name:ON2FEET, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENNUTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-391-3344
Mailing Address - Street 1:PO BOX 470118
Mailing Address - Street 2:
Mailing Address - City:LAKE MONROE
Mailing Address - State:FL
Mailing Address - Zip Code:32747-0118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1319 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 1161
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1408
Practice Address - Country:US
Practice Address - Phone:407-391-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3428213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty