Healthcare Provider Details

I. General information

NPI: 1114215498
Provider Name (Legal Business Name): FLORIDA BRACING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 GLYNCO PKWY BUILDING 2, SUITE 110
BRUNSWICK GA
31525-7921
US

IV. Provider business mailing address

500 SE 17TH ST SUITE 301
FORT LAUDERDALE FL
33316-2547
US

V. Phone/Fax

Practice location:
  • Phone: 912-262-1716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR65
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES MATTERN
Title or Position: PRESIDENT
Credential:
Phone: 954-917-5655