Healthcare Provider Details

I. General information

NPI: 1538641774
Provider Name (Legal Business Name): BRACE YOURSELF ORTHOTICS & PROSTETICS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W VALLEY AVE
BIRMINGHAM AL
35209-3691
US

IV. Provider business mailing address

181 W VALLEY AVE
BIRMINGHAM AL
35209-3691
US

V. Phone/Fax

Practice location:
  • Phone: 205-919-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC52232
License Number StateAL

VIII. Authorized Official

Name: ANTWAUN BURROUGHS
Title or Position: OWNER
Credential:
Phone: 205-919-3900