Healthcare Provider Details

I. General information

NPI: 1316057219
Provider Name (Legal Business Name): FLORIDA BRACE & LIMB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6219 66TH ST N
PINELLAS PARK FL
33781-5025
US

IV. Provider business mailing address

2445 TAMPA RD STE H
PALM HARBOR FL
34683-5849
US

V. Phone/Fax

Practice location:
  • Phone: 727-548-1808
  • Fax: 727-548-1945
Mailing address:
  • Phone: 727-786-0880
  • Fax: 727-786-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPOR 57
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberPOR 57
License Number StateFL

VIII. Authorized Official

Name: MR. MORRIS M YASOVA
Title or Position: PRESIDENT
Credential:
Phone: 727-786-0880