MEDICARE: INNOVATIVE ORTHOTICS & REHABILITATION 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		GA

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	:	1952395261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE ORTHOTICS & REHABILITATION INC

Provider Business Mailing Address
First Line	:	1300 DEKALB AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2027
Country	:	US
Telephone Number	:	404-222-9998
Fax Number	:	404-222-9958

Provider Business Practice Location Address
First Line	:	1300 DEKALB AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2027
Country	:	US
Telephone Number	:	404-222-9998
Fax Number	:	404-222-9958

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. ANGELIA S DEFRANCIS
Credential	:	PARTNER
Telephone Number	:	404-222-9998

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	08/22/2020

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