Healthcare Provider Details

I. General information

NPI: 1780985911
Provider Name (Legal Business Name): BROOKS PROSTHETICS AND ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 MILLS AVE STE 101B
GREENVILLE SC
29605-5602
US

IV. Provider business mailing address

527 MILLS AVE STE 101B
GREENVILLE SC
29605-5602
US

V. Phone/Fax

Practice location:
  • Phone: 864-282-5213
  • Fax: 864-282-5214
Mailing address:
  • Phone: 864-282-5213
  • Fax: 864-282-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERI LECKIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-282-5213