Healthcare Provider Details

I. General information

NPI: 1154585651
Provider Name (Legal Business Name): TOTAL BODY ORTHOTICS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 MAHONING AVE SUITE 5
AUSTINTOWN OH
44515-2437
US

IV. Provider business mailing address

5437 MAHONING AVE SUITE 5
AUSTINTOWN OH
44515-2437
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-8205
  • Fax: 330-793-8357
Mailing address:
  • Phone: 330-793-8205
  • Fax: 330-793-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. BORIS VAKS
Title or Position: PRESIDENT
Credential:
Phone: 330-793-8205