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General NPI Number Information
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NPI Number | 1326319633
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Entity Type | Organization
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Legal Business Name | TENNESSEE LIMB AND BRACE LLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 735 W JACKSON ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-3993
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Country | US
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Telephone | 931-854-9455
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Fax |
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Provider Business Mailing Address
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Address Line | 735 W JACKSON ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-3993
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Country | US
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Telephone | 931-854-9455
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BARRY D DAVIDSON
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Credential |
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Telephone | 931-854-9455
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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 | ORT-6
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PRO-7
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License Number State | TN
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