MEDICARE: TREASURE COAST PEDORTHICS INC

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	335E00000X	Prosthetic/Orthotic Supplier	PED 78	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356538821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE COAST PEDORTHICS INC

Provider Business Mailing Address
First Line	:	2686 US HIGHWAY 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5080
Country	:	US
Telephone Number	:	772-562-9045
Fax Number	:	772-562-9436

Provider Business Practice Location Address
First Line	:	2686 US HIGHWAY 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5080
Country	:	US
Telephone Number	:	772-562-9045
Fax Number	:	772-562-9436

Authorized Official
Title or Position	:	OWNER / OPERATOR
Name	:	ALTHEA POWELL
Credential	:	C.PED, L.PED
Telephone Number	:	772-562-9045

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	12/07/2015

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