Provider Demographics
NPI:1316533532
Name:FOOT & ANKLE PROFESSIONAL PODIATRY PLLC
Entity type:Organization
Organization Name:FOOT & ANKLE PROFESSIONAL PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HEPBURN RUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-984-3317
Mailing Address - Street 1:1908 MACDADE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-1316
Mailing Address - Country:US
Mailing Address - Phone:215-391-9583
Mailing Address - Fax:
Practice Address - Street 1:1908 MACDADE BLVD STE A
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-1316
Practice Address - Country:US
Practice Address - Phone:215-391-9583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-13
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty