MEDICARE: CUSTOM ARTIFICIAL LIMB AND BRACE, 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

General Provider Information

NPI Number	:	1508586694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSTOM ARTIFICIAL LIMB AND BRACE, INC.

Provider Business Mailing Address
First Line	:	491 E BRUCETON RD
Second Line	:
City	:	PLEASANT HILLS
State	:	PA
Zip	:	15236-5525
Country	:	US
Telephone Number	:	724-654-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	491 E BRUCETON RD
Second Line	:
City	:	PLEASANT HILLS
State	:	PA
Zip	:	15236-5525
Country	:	US
Telephone Number	:	724-654-3991
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	BOBBY COLES
Credential	:
Telephone Number	:	724-654-3991

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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