Healthcare Provider Details

I. General information

NPI: 1306838792
Provider Name (Legal Business Name): SONLIFE PROSTHETICS & ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 HIGHWAY 44 W
INVERNESS FL
34453-3804
US

IV. Provider business mailing address

2024 HIGHWAY 44 W
INVERNESS FL
34453-3804
US

V. Phone/Fax

Practice location:
  • Phone: 352-344-8200
  • Fax: 352-344-5997
Mailing address:
  • Phone: 352-344-8200
  • Fax: 352-344-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR 16
License Number StateFL

VIII. Authorized Official

Name: MRS. THERESA J. WALKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-596-2257