Healthcare Provider Details

I. General information

NPI: 1619843430
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 DICK POND RD STE A
MYRTLE BEACH SC
29588-6810
US

IV. Provider business mailing address

3611 5TH AVE N
ST PETERSBURG FL
33713-7503
US

V. Phone/Fax

Practice location:
  • Phone: 704-557-0700
  • Fax: 704-307-2871
Mailing address:
  • Phone: 727-327-3332
  • Fax: 727-327-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHRISTINA GELAZNIK
Title or Position: DIRECTOR OF OPERATIONS & FINANCE
Credential:
Phone: 727-327-3332