MEDICARE: ORTHO FLORIDA, LLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1902621105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO FLORIDA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 978766
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75397-8766
Country	:	US
Telephone Number	:	561-300-1787
Fax Number	:

Provider Business Practice Location Address
First Line	:	7280 W PALMETTO PARK RD STE 104N
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3401
Country	:	US
Telephone Number	:	561-401-0422
Fax Number	:

Authorized Official
Title or Position	:	OF CEO
Name	:	DANE TRASK
Credential	:
Telephone Number	:	813-787-1128

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	04/01/2025

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