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Organization

ACTIVE FOOT AND ANKLE CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WHITNEY RAE HOLSOPPLE D.P.M (OWNER)
(937) 875-2526
Entity
Organization

Contact information

Practice address
300 S DORSET RD, TROY, OH 45373-2635
(937) 875-2526
(937) 459-5433
Mailing address
300 S DORSET RD, TROY, OH 45373-2635
(937) 875-2526
(937) 459-5433

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
36003402
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6077150001
DMERC
OH
Enumeration date
09/21/2012
Last updated
12/17/2019
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