Healthcare Provider Details

I. General information

NPI: 1265015622
Provider Name (Legal Business Name): UNITY PROSTHETICS AND ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 PRIMERA BLVD STE 205
LAKE MARY FL
32746-2127
US

IV. Provider business mailing address

725 PRIMERA BLVD STE 205
LAKE MARY FL
32746-2127
US

V. Phone/Fax

Practice location:
  • Phone: 407-232-9944
  • Fax: 407-232-9966
Mailing address:
  • Phone: 407-232-9944
  • Fax: 407-232-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN JUMP
Title or Position: PRESIDENT
Credential: CPO
Phone: 407-232-9944