Healthcare Provider Details

I. General information

NPI: 1043667025
Provider Name (Legal Business Name): BOSTON BRACE INTERNATIONAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 LEE ANN DR NE STE 50
CONCORD NC
28025-2903
US

IV. Provider business mailing address

1028 LEE ANN DR NE STE 50
CONCORD NC
28025-2903
US

V. Phone/Fax

Practice location:
  • Phone: 980-781-1521
  • Fax: 980-781-1526
Mailing address:
  • Phone: 980-781-1521
  • Fax: 980-781-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: THOMAS H MORRISSEY
Title or Position: GENERAL MANAGER
Credential:
Phone: 508-588-6060