Healthcare Provider Details

I. General information

NPI: 1013482546
Provider Name (Legal Business Name): WESTCOAST BRACE & LIMB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N MAITLAND AVE STE 210
MAITLAND FL
32751-4771
US

IV. Provider business mailing address

5311 E FLETCHER AVE
TEMPLE TERRACE FL
33617-1147
US

V. Phone/Fax

Practice location:
  • Phone: 813-985-5000
  • Fax: 813-985-4499
Mailing address:
  • Phone: 813-985-5000
  • Fax: 813-985-4499

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: SHARON DORR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 813-985-5000