Healthcare Provider Details

I. General information

NPI: 1790781482
Provider Name (Legal Business Name): GARRISON'S ORTHOTHIC & PROSTHETIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6748
US

IV. Provider business mailing address

1531 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6748
US

V. Phone/Fax

Practice location:
  • Phone: 954-960-8757
  • Fax: 305-949-5546
Mailing address:
  • Phone: 954-960-8747
  • Fax: 305-949-5546

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: MR. KEVIN S. GARRISON
Title or Position: PRESIDENT
Credential: C.P., L.P.
Phone: 954-960-8747