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General NPI Number Information
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NPI Number | 1093150575
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC BRACES
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 206 WESTSIDE DR
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City | TULLAHOMA
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State | TN
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Zip | 37388
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Country | US
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Telephone | 931-563-7142
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Fax | 931-563-7142
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Provider Business Mailing Address
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Address Line | 206 WESTSIDE DR
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City | TULLAHOMA
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State | TN
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Zip | 37388-3255
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Country | US
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Telephone | 931-563-7142
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Fax | 931-563-7142
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Authorized Official
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Title or Position | ORTHOTIST/PROSTHETIST OWNER
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Name | EDWIN DOWNS
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Credential | CO
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Telephone | 931-563-7142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | ORT0000000208
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License Number State | TN
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