Healthcare Provider Details

I. General information

NPI: 1346559507
Provider Name (Legal Business Name): SOUTH BEACH ORTHOTICS & PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 S COLORADO AVE
STUART FL
34994-3005
US

IV. Provider business mailing address

4147 SUN N LAKE BLVD
SEBRING FL
33872-2131
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-9426
  • Fax: 772-872-3010
Mailing address:
  • Phone: 863-658-1291
  • Fax: 863-884-1593

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: IVAN SABEL
Title or Position: CEO
Credential:
Phone: 863-658-1291