Organization Name: | BROADWAY FOOT & ANKLE PS |
NPI Number: | 1265470678 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARRY L LICHTER (SOLE PROPRIETOR) |
Mailing Address: | 6625 W Crest View Loop Se Snoqualmie |
State: | WA US |
Postal Code: | 980658912 |
Phone Number: | 4253965424 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2006 |
NPI Last Update Date: | 06/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213EP1101X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Primary Podiatric Medicine |
Taxonomy Definition: |