| Organization Name: | PEACE RIVER ANKLE & FOOT, PL |
| NPI Number: | 1023329331 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HOLLY K WADDELL (OWNER/PODIATRIST) |
| Mailing Address: | 3440 Conway Blvd 1d Port Charlotte |
| State: | FL US |
| Postal Code: | 339527000 |
| Phone Number: | 9416243668 |
| Fax Number: | |
| NPI Enumeration Date: | 07/01/2010 |
| NPI Last Update Date: | 03/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | PO3264 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |