Organization
ACTIVE FOOT AND ANKLE CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD LIETTE (OFFICE MANAGER)
(937) 875-2526
Entity
Organization
Contact information
Practice address
828 CENTRAL AVE, GREENVILLE, OH 45331-1206
(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
261QP1100X
Podiatric Clinic/Center
Primary
36003402
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2543279
—
OH
Enumeration date
02/07/2008
Last updated
12/04/2014
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