Healthcare Provider Details

I. General information

NPI: 1801994934
Provider Name (Legal Business Name): ORTHOTIC PROSTHETIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 MANATEE AVENUE WEST
BRADENTON FL
34205-4939
US

IV. Provider business mailing address

2717 MANATEE AVENUE WEST
BRADENTON FL
34205-4939
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2521
  • Fax: 941-749-0864
Mailing address:
  • Phone: 941-748-2521
  • Fax: 941-749-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORT9
License Number StateFL

VIII. Authorized Official

Name: MR. CHARLES D BROWN
Title or Position: PRESIDENT
Credential: CO
Phone: 941-748-2521