Healthcare Provider Details

I. General information

NPI: 1528024999
Provider Name (Legal Business Name): CHILDREN'S BRACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W GOVERNOR RD
HERSHEY PA
17033-2217
US

IV. Provider business mailing address

710 S YORK ST
MECHANICSBURG PA
17055-4745
US

V. Phone/Fax

Practice location:
  • Phone: 717-790-0600
  • Fax: 717-790-0617
Mailing address:
  • Phone: 717-790-0600
  • Fax: 717-790-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6000005984
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0019006770001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: BERNARD J FURR
Title or Position: ORTHOTIST
Credential: C.O.
Phone: 717-790-0600