Healthcare Provider Details

I. General information

NPI: 1053667071
Provider Name (Legal Business Name): FLORIDA BRACING CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAINT CHARLES AVE SUITE 2542
NEW ORLEANS LA
70170-1000
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 504-599-5639
  • Fax: 504-599-5629
Mailing address:
  • Phone: 954-917-5655
  • Fax: 954-971-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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