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General NPI Number Information
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NPI Number | 1063608305
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Entity Type | Organization
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Legal Business Name | ORTHOTICS CHOICE
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 451 E AIRPORT BLVD
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City | SANFORD
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State | FL
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Zip | 32773-5494
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Country | US
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Telephone | 407-321-0454
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Fax | 407-321-8979
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Provider Business Mailing Address
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Address Line | 451 E AIRPORT BLVD
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City | SANFORD
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State | FL
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Zip | 32773-5494
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Country | US
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Telephone | 407-321-0454
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Fax | 407-321-8979
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Authorized Official
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Title or Position | V.P./OWNER
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Name | DR. MARK L NALLEY SR.
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Credential | D.C.
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Telephone | 407-321-0454
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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 |
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License Number State |
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