Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Elite Sports Podiatry, PA

Organization Foot Surgery Podiatrist · NPI 1356743207

Elite Sports Podiatry, PA is a Foot Surgery Podiatrist in Clearwater, Florida. Licensed in Florida. Registered with an NPI since 2014.

Licensed in
FL
In the registry since
2014
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1700 N McMullen Booth Rd Ste C-2
Clearwater, FL 33759-2130
Phone: (727) 330-7646
Fax: (727) 330-4645
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Foot Surgery Podiatrist (primary) Taxonomy 213ES0131X · Licence PO3445 (FL)

Record details

NPI number1356743207
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brian Fullem — Medical Doctor/Owner · (203) 241-2582
NPI enumeratedSeptember 23, 2014
Last updated in NPPESJanuary 7, 2015
Mailing address1700 N McMullen Booth Rd Ste C2, Clearwater, FL 33759-2129

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