Provider Demographics
NPI:1578441507
Name:TSB PODIATRY PLLC
Entity type:Organization
Organization Name:TSB PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:SHAKESPEAR
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-528-3725
Mailing Address - Street 1:7414 RAVENSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4741
Mailing Address - Country:US
Mailing Address - Phone:817-528-3725
Mailing Address - Fax:
Practice Address - Street 1:1630 W PROSPER TRL STE 140
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3743
Practice Address - Country:US
Practice Address - Phone:817-528-3725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric