Healthcare Provider Details

I. General information

NPI: 1508674631
Provider Name (Legal Business Name): ORTHOPAEDIC TOI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5438 PINE LILLY DR
SAINT CLOUD FL
34771-0120
US

IV. Provider business mailing address

PO BOX 701795
SAINT CLOUD FL
34770-1795
US

V. Phone/Fax

Practice location:
  • Phone: 407-751-0223
  • Fax:
Mailing address:
  • Phone: 407-751-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ALEXANDER RODRIGUEZ LOPEZ
Title or Position: CEO
Credential:
Phone: 407-751-0223