Healthcare Provider Details

I. General information

NPI: 1598950784
Provider Name (Legal Business Name): FLORIDA BRACING CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MELALEUCA DRIVE
MARGATE FL
33063
US

IV. Provider business mailing address

500 SE 17TH ST SUITE 300
FT LAUDERDALE FL
33316-2547
US

V. Phone/Fax

Practice location:
  • Phone: 954-917-5655
  • Fax: 954-971-7773
Mailing address:
  • Phone: 954-525-6700
  • Fax: 954-525-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPOR65
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberPOR65
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES MATTERN
Title or Position: PRESIDENT
Credential:
Phone: 954-917-5655