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General NPI Number Information
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NPI Number | 1144692013
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Entity Type | Organization
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Legal Business Name | BREVARD PROSTHETICS & ORTHOTICS, INC
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 10201 ARCOS AVE STE 104
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City | ESTERO
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State | FL
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Zip | 33928-9460
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Country | US
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Telephone | 239-955-4778
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Fax | 321-638-4559
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Provider Business Mailing Address
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Address Line | 8695 CONNECTICUT ST STE E
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6240
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Country | US
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Telephone | 321-225-8001
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Fax | 321-225-4046
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Authorized Official
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Title or Position | CONTRACTING MANAGER
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Name | LAURA ALLEN
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Credential |
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Telephone | 336-339-9671
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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 | FL
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