Healthcare Provider Details

I. General information

NPI: 1376927285
Provider Name (Legal Business Name): PROSTHETIC ORTHOTIC DESIGNS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8445 SW 132ND ST
PINECREST FL
33156-6505
US

IV. Provider business mailing address

8445 SW 132ND ST
PINECREST FL
33156-6505
US

V. Phone/Fax

Practice location:
  • Phone: 305-699-9916
  • Fax: 844-287-2552
Mailing address:
  • Phone: 305-699-9916
  • Fax: 844-287-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR 187
License Number StateFL

VIII. Authorized Official

Name: MR. ADAM ROSS FINNIESTON
Title or Position: PRESIDENT
Credential: CPO
Phone: 305-699-9916