=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205968013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST PETERSBURG LIMB AND BRACE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 37TH ST N STE B
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-321-3900
-----------------------------------------------------
Fax | 727-323-9516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 37TH ST N STE B
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33713-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-321-3900
-----------------------------------------------------
Fax | 727-323-9516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | ANDREW TYLER HOCZ
-----------------------------------------------------
Credential | CPO
-----------------------------------------------------
Telephone | 727-321-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------