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General NPI Number Information
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NPI Number | 1023446895
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Entity Type | Organization
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Legal Business Name | ABOUT YOU BRACE AND LIMB, LLC
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 1255 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4501
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Country | US
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Telephone | 386-323-7990
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Fax | 386-323-7992
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Provider Business Mailing Address
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Address Line | 1255 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4501
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Country | US
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Telephone | 386-323-7990
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Fax | 386-323-7992
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Authorized Official
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Title or Position | ORTHOTIST
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Name | MR. PAUL BOURQUE
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Credential | CO
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Telephone | 386-323-7990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | ORT6
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License Number State | FL
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