Healthcare Provider Details

I. General information

NPI: 1063414993
Provider Name (Legal Business Name): CARDINAL PROSTHETICS & ORTHOTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13240 N CLEVELAND AVE SUITE #1
FORT MYERS FL
33903-4855
US

IV. Provider business mailing address

13240 N CLEVELAND AVE SUITE #1
FORT MYERS FL
33903-4855
US

V. Phone/Fax

Practice location:
  • Phone: 239-995-4777
  • Fax: 239-995-9777
Mailing address:
  • Phone: 239-995-4777
  • Fax: 239-995-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR 54
License Number StateFL

VIII. Authorized Official

Name: MR. STEVEN LAWRENCE FRIES
Title or Position: PRESIDENT/OWNER
Credential: LPO
Phone: 239-995-4777