Provider Demographics
NPI:1730697897
Name:FINAL KICK ANKLE AND FOOT CLINIC LLC
Entity type:Organization
Organization Name:FINAL KICK ANKLE AND FOOT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKULIC
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-687-5191
Mailing Address - Street 1:348 E 4500 S STE 370
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3906
Mailing Address - Country:US
Mailing Address - Phone:385-770-7203
Mailing Address - Fax:385-770-7202
Practice Address - Street 1:476 WILLIAMS WAY STE B
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2186
Practice Address - Country:US
Practice Address - Phone:435-719-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FINAL KICK ANKLE AND FOOT CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty