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General NPI Number Information
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NPI Number | 1306082722
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Entity Type | Organization
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Legal Business Name | NEWBOLD PROSTHETICS, LLC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 1547 7TH ST SW
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3802
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Country | US
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Telephone | 863-293-5444
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Fax | 863-293-5446
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Provider Business Mailing Address
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Address Line | 1547 7TH ST SW
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3802
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Country | US
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Telephone | 863-293-5444
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Fax | 863-293-5446
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Authorized Official
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Title or Position | CERTIFIED PRACTIONER/OWNER
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Name | MR. CLEMENT BUCKLEY NEWBOLD III
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Credential | C.P.
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Telephone | 863-293-5444
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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 | PRO108
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License Number State | FL
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