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General NPI Number Information
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NPI Number | 1215420914
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Entity Type | Organization
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Legal Business Name | TKO ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 200 E WASHINGTON ST UNIT B
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City | MINNEOLA
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State | FL
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Zip | 34715-9209
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Country | US
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Telephone | 352-242-0599
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Fax | 352-242-0599
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Provider Business Mailing Address
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Address Line | 200 E WASHINGTON ST UNIT B
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City | MINNEOLA
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State | FL
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Zip | 34715-9209
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Country | US
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Telephone | 352-242-0599
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Fax | 352-242-0599
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Authorized Official
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Title or Position | PRESIDENT
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Name | DWAYNE JAMES HELM
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Credential |
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Telephone | 352-242-7723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number | PED235
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License Number State | FL
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