MEDICARE: MR. DUSTIN RAY PRINGLE BOCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	OH000211	PA

General Provider Information

NPI Number	:	1245725084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUSTIN RAY PRINGLE BOCO

Provider Business Mailing Address
First Line	:	903 GRAMBLING ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-1721
Country	:	US
Telephone Number	:	814-266-1788
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 GRAMBLING ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-1721
Country	:	US
Telephone Number	:	814-266-1788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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Directions to “ MR. DUSTIN RAY PRINGLE BOCO” Practice Location

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