Healthcare Provider Details

I. General information

NPI: 1104177401
Provider Name (Legal Business Name): ORTHOTIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4837 TAYLORSVILLE HWY
STONY POINT NC
28678-9050
US

IV. Provider business mailing address

4837 TAYLORSVILLE HWY
STONY POINT NC
28678-9050
US

V. Phone/Fax

Practice location:
  • Phone: 215-949-3636
  • Fax: 267-522-8364
Mailing address:
  • Phone: 215-949-3636
  • Fax: 267-522-8364

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. CURTIS GREGORY
Title or Position: OWNER
Credential:
Phone: 215-609-0122