Provider Demographics
NPI:1689499436
Name:REBEL FOOT & ANKLE
Entity type:Organization
Organization Name:REBEL FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-889-5324
Mailing Address - Street 1:1430 GADSDEN HWY SUITE #116 UNIT #2433
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3103
Mailing Address - Country:US
Mailing Address - Phone:801-889-5324
Mailing Address - Fax:
Practice Address - Street 1:1601 VETERANS DR UNIT 112
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769-3716
Practice Address - Country:US
Practice Address - Phone:801-889-5324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty