Healthcare Provider Details

I. General information

NPI: 1851982201
Provider Name (Legal Business Name): POWER PROSTHETIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9259 LAKE FISCHER BLVD
GOTHA FL
34734-5204
US

IV. Provider business mailing address

9259 LAKE FISCHER BLVD
GOTHA FL
34734-5204
US

V. Phone/Fax

Practice location:
  • Phone: 850-247-8975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE FREDRICK
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-247-8975