Healthcare Provider Details

I. General information

NPI: 1174526396
Provider Name (Legal Business Name): SONLIFE PROSTHETICS & ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 DELTONA BLVD
SPRING HILL FL
34606-1011
US

IV. Provider business mailing address

6111 DELTONA BLVD
SPRING HILL FL
34606-1011
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-2257
  • Fax: 352-596-0180
Mailing address:
  • Phone: 352-596-2257
  • Fax: 352-596-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR 16
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID S. GORIS
Title or Position: PRESIDENT
Credential: LPO
Phone: 352-596-2257